Procoagulant Phospholipids and Tissue Factor Activity in Cerebrospinal Fluid from Patients with Intracerebral Haemorrhage

Abstract

Brain contains large amounts of tissue factor, the major initiator of the coagulation cascade. Neuronal apoptosis after intracerebral haemorrhage (ICH) leads to the shedding of procoagulant phospholipids (PPLs). The aim of this study was to investigate the generation of PPL, tissue factor activity (TFa), and D-Dimer (D-Di) in the cerebrospinal fluid (CSF) at the acute phase of ICH in comparison with other brain diseases and to examine the relationship between these factors and the outcome of ICH. CSF was collected from 112 patients within 48 hours of hospital admission. Thirty-one patients with no neurological or biochemical abnormalities were used to establish reference range in the CSF (“controls”). Thirty had suffered an ICH, and 51 other neurological diagnoses [12: ventricular drainage following brain surgery, 13: viral meningitis, 15: bacterial meningitis, and 11 a neurodegenerative disease (NDD)]. PPL was measured using a factor Xa-based coagulation assay and TFa by one home test. PPL, D-Di, and TFa were significantly higher (P < 0.001) in the CSF of patients with ICH than in controls. TFa levels were significantly (P < 0.05) higher in ICH than in patients with meningitides or NDD. Higher levels (P < 0.05) of TFa were observed in patients with ICH who died than in survivors. TFa measurement in the CSF of patients with ICH could constitute a new prognostic marker.

Variation of membrane particle–bound CD133 in cerebrospinal fluid of patients with subarachnoid and intracerebral hemorrhage

“…Several proteins in CSF have been examined to constitute a possible prognostic factor for outcome in these diseases. 35,38 Analysis of membraneassociated particles represents an interesting tool for monitoring neurological disease because cell membrane dynamics are tracked, which may shed light on the severity of the disease. 2 The key question remains: why is a persistent or second elevation of CD133 levels linked to functional outcome?…”

The influence of cerebrospinal fluid on blood coagulation and the implications for ventriculovenous shunting

“…6 In pathological conditions, the concentration of coagulation proteins and the imbalance between tissue factor and tissue factor pathway inhibitor even increase, resulting in a more pronounced procoagulant ef-fect of CSF. 26 Further research is necessary to elucidate this mechanism.…”

Serum soluble CD40 ligand levels after acute intracerebral hemorrhage

“…Among these patients, 96 (87.3%) patients had hypertension and 27 (24.6%) patients had diabetes mellitus. On admission, the mean NIHSS score was 11.6 ± 4.6 and the mean hematoma volume was 30.3 ± 10.4 ml (5–60 ml). Thirty‐one (28.2%) patients suffered from the presence of intraventricular hemorrhage; 14 (12.7%) patients, hemorrhage growth; 18 (16.4%) patients, early neurological deterioration.…”

“…However, excessive activation of the blood coagulation process can induce a blood coagulation disorder due to excessive consumption of blood coagulation factor and, in severe cases, induces disseminated intravascular coagulation disorder. This activation of tissue factors affects the blood coagulation disorder by inducing changes in blood coagulation factors, therefore enhancing the risk of hematoma growth . Overall, inflammation and hypercoagulability play crucial roles in the pathophysiology of ICH .…”