D-dimer Predict Poor Outcome and Early Brain Injury after Aneurysmal Subarachnoid Hemorrhage. (16th November 2020)

• Record Type: Journal Article
• Authors: Hokari, Masaaki; Uchida, Kazuki; Shimbo, Daisuke; Asaoka, Katsuyuki; Itamoto, Koji
• Is Part Of: Neurosurgery. Volume 67(2010)Supplement 1
• Publication Date: 2020-11-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyaa447_302
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Recently, a major factor contributing to functional outcomes after subarachnoid hemorrhage (SAH) has been proposed to be the early brain injury (EBI) followed by initial hemorrhage. However, pathological mechanism of EBI remained obscure. During aneurysm rupture, blood contacts the extravascular matrix, leading to an activation of both blood coagulation and fibrinolysis. Several investigators reported elevated plasma D-dimer predicts poor outcome, suggesting that hyper-coagulate state may be associate with early brain ischemic injury. METHODS: This study included 88 patients hospitalized within 24 hours from onset for non-traumatic SAH. Patients underwent MRI within 0–3 days from onset (prior to vasospasm) to detect EBI. EBI was radiologically defined as DWI positive, ADC dark lesions, excluding lesions that were procedure related. EBI and plasma D-dimer level, and clinical features were investigated retrospectively. RESULTS: Elevated D-dimer was associated with poor outcomes. EBI were detected in 24 patients of all (27.3%). Patients with EBI had significantly higher D-dimer than patients without no EBI (11.9 ± 14.1 vs 4.6 ± 6.0). EBI were detected in 2 of 39 WFNS grade 1–3 patients (5.1%), but 22 of 49 WFNS 4–5 patients (45%). EBI was frequently observed in the para-medial frontal lobe. CONCLUSION: This study suggested that D-dimer predicted for poor outcome in patients with SAH, and that EBI was associated high D-dimer. Further investigation is needed to confirm whether suppression of hyper-coagulation can lead to good outcome.