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document
D-dimer predicts outcome after aneurysmal subarachnoid hemorrhage : no effect of thromboprophylaxis on coagulation activity . OBJECTIVE Approximately one-third of all patients with acute nontraumatic subarachnoid hemorrhage ( SAH ) experience complications owing to delayed ischemic deficit . We reported recently that enoxaparin 40 mg once daily for 10 days seems safe and demonstrates thromboprophylactic efficacy , but it failed to improve outcome in a randomized SAH trial . In the present study , we assessed hemostatic variables associated with clinical status and outcome of SAH . We also monitored the effect of enoxaparin on activation of coagulation and fibrinolysis after closure of the ruptured aneurysm . METHODS Blood samples to measure activation of coagulation and fibrinolysis were collected from 42 patients participating in the enoxaparin trial for acute aneurysmal SAH at four time points : 1 ) at hospital admission ; 2 ) 12 to 24 hours after aneurysm surgery but before initiation of enoxaparin therapy ; 3 ) 3 hours after the first dose ; and 4 ) at the conclusion of treatment . RESULTS At admission , several variables of coagulation and fibrinolysis were elevated and correlated well with clinical status . Specifically , D-dimer levels at all four time points correlated with patients ' long-term outcomes . A single dose of enoxaparin suppressed early coagulation activity , but thrombin generation was not inhibited during thromboprophylaxis . However , PAI-1 activity was suppressed . CONCLUSION D-dimer offers a useful laboratory tool for assessing early and late clinical severity of SAH . A thromboprophylactic dose of enoxaparin inhibited PAI-1 activity but failed to down-regulate coagulation activity and D-dimer . These findings are compatible with the lack of efficacy of enoxaparin in reducing ischemic deficit after SAH .
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Intervention_Pharmacological
enoxaparin
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Outcome_Physical
coagulation activity
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Outcome_Other
thromboprophylactic efficacy
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Outcome_Physical
hemostatic variables
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Outcome_Physical
activation of coagulation and fibrinolysis
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Outcome_Other
Blood samples
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Outcome_Physical
activation of coagulation
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Outcome_Physical
fibrinolysis
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Outcome_Physical
variables of coagulation and fibrinolysis
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Outcome_Physical
D-dimer levels
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Outcome_Physical
early coagulation activity
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Outcome_Physical
thrombin generation
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Outcome_Physical
PAI-1 activity
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Outcome_Physical
severity of SAH
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Outcome_Physical
PAI-1 activity
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Outcome_Physical
coagulation activity and D-dimer
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Participant_Condition
subarachnoid hemorrhage :
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Participant_Condition
acute nontraumatic subarachnoid hemorrhage ( SAH )
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Participant_Sample-size
42
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Participant_Condition
acute aneurysmal SAH