Fibrinolytic activity of the cerebrospinal fluid after subarachnoid haemorrhage.

Abstract

The fibrinolytic activity of peripheral blood and cerebrospinal fluid was estimated by the fibrin plate method and by assays for fibrin degradation products in 11 patients with proven aneurysmal subarach-noid haemorrhage. Five of the patients were treated conservatively; the remaining 6, surgically. An increase in the fibrinolytic activity of the cerebrospinal fluid, as judged from the appearance of fibrin degradation products, occurred in all the patients on the third day after the initial haemorrhage. This fibrinolytic activity tended to decrease the first three weeks after the onset of the haemorrhage in 7 patients. In the remaining 4 it was still elevated at the end of the third week. In one of these patients haemorrhage recurred. Demonstration of high concentrations of fibrin degradation products in cerebrospinal fluid after surgery on the brain suggests the release of tissue activators from the damaged brain during the operation. Premature dissolution of the haemostatic plug at the site of the ruptured intra-cranial aneurysm might therefore be responsible for the rebleeding. Hence the use of anti-fibrinolytic drugs may be useful in the management of patients with subarachnoid haemorrhage.