To test the hypothesis that an impaired coagulation system facilitates rapid expansion of
hypertensive intracerebral hemorrhage (HICH), coagulation markers were assayed in plasma and their relations to both the
hemorrhage size and its progressive expansion were analyzed. Ninety patients with HICH were studied. On admission, plasma samples were taken for the coagulation assay.
Hematoma volume was calculated from a computed tomography (CT) scan and its enlargement was estimated by comparison to the volume of the
hematoma calculated from a second CT scan taken later within 24 hr. Nine out of 90 patients showed enlargement in their
hematoma size (enlarged
hematoma group). Four of the enlarged
hematoma group fell into acute fatal deterioration and died. Plasma levels of both fibrino
peptide A (17.2+/-7.8 vs. 4.0+/-0.6 ng/ml, P < 0.05) and
thrombin-antithrombin complex (21.9+/-3.1 vs. 7.4+/-2.8 ng/ml, not significant) were higher in the unchanged group than those in the enlarged
hematoma group. In the
hematoma-enlarged group fibrino-
peptide A level did not exceed 10 ng/ml. In the
hematoma unchanged group
thrombin-AT-III complex values were positively correlated to
hematoma volume. Thus, the coagulation system seemed to be highly activated depending on the
hemorrhage volume within three hr after ictus in
hypertensive intracerebral hemorrhage patients. When
thrombin generation was not sufficient after
bleeding, the
hematoma seemed to be progressively enlarged. In conclusion, plasma levels of the coagulation markers on admission could be useful predictors of the possible enlargement of
hematoma which leads to a poor outcome.