Vol.5, No 1, 1998 pp. 44 - 49
UDC: 618.38
BLOOD COAGULATION AND FIBRINOLYSIS PARAMETER CHANGES
AFTER VARIOUS TYPES OF BRAIN DAMAGE
Jovan Antović1, Milorad Bakić1, Goran Ignjatović2, Zoran Milenković2,
Stojanka Djurić3, Jovan Tasić1, Mladen Milenović1
1Clinic of Hematology and Clinical Immunology,  2Neurosurgery Clinic, 3Clinic of Neurology,
Faculty of Medicine, Niš, Serbia, FRY
Summary. Brain tissue, especially astrocytes, is one of the richest sources of tissue factor (TF) in the human organism. Simultaneously, tissue plasminogen activator (t-PA) has been found in brain blood vessels. Various brain damage induces release of TF and fibrinolysis activators into circulation, and leads to hemostatic disturbances. We have investigated some coagulation and fibrinolysis parameters in 120 patients with various brain damage (30 with isolated head trauma; 30 after brain tumor surgery, 30 after ischemic and 30 after haemorrhagic stroke). Blood samples taken in the first 24 hours after brain damage were determined by the following parameters: prothrombin time (PT), fibrinogen, activated partial thromboplastin time (aPTT), activity of FVII, antithrombin III (ATIII) and alpha-2 antiplasmin (alpha-2 AP), and D-dimer. Significant decreases of PT, FVII, ATIII and increase of D-dimer have been noticed in all groups,  most significant after head trauma. Alpha-2 AP has been decreased only after brain tumor surgery.  Although described abnormalities did not demanded supportive and/or anticoagulant treatment, their presence in most of investigated patients should be the enough of a reason for routine coagulation investigation in the first 24 hours after brain damage.
Key words: Blood coagulation, fibrinolysis, brain damage
PROMENE PARAMETARA KOAGULACIJE I FIBRINOLIZE
NAKON RAZLIČITIH TIPOVA OŠTEĆENJA MOZGA

Dobro je poznato da je moždano tkivo jedno od tkiva najbogatijih tkivnim faktorom (TF) u ljudskom organizmu. TF se nalazi u sivoj masi, naročito u astrocitima. Sa druge strane tkivni aktivator plazminogena (t-PA) je otkriven u krvnim sudovima mozga. Oštećenje mozga uzrokovano različitim etiološkim faktorima, dovodi do oslobađanja TF-a i aktivatora fibrinolize u cirkulaciju uzrokujući tako hemostatske poremećaje. Mi smo ispitivali neke koagulacione i fibrinolitičke parametre kod 120 pacijenata sa različitim tipovima oštećenja mozga (30 sa izolovanom traumom glave, 30 nakon operacije tumora mozga, 30 nakon ishemijskog i 30 nakon hemoragijskog cerebrovaskularnog inzulta (CVI)). Krv je uzimana u prva 24 sata nakon oštećenja mozga i određivani su sledeći parametri: protrombinsko vreme (PT), fibrinogen, aktivisano parcijalno tromboplastinsko vreme (aPTT), aktivnost FVII, antitrombina III (ATIII), alfa-2 antiplazmina (alfa-2AP) i D-dimer. Značajno smanjenje PT-a, FVII i ATIII, kao i porast D-dimera je zapažen u svim grupama. Ove promene su najizrazitije nakon traume glave. Alfa-2AP je snižen samo nakon operacije tumora mozga. Iako hemostatske abnormalnosti nakon različitih tipova oštećenja mozga nisu zahtevale suportivni i/ili antikoagulantni tretman, mišljenja smo da je prisustvo ovih abnormalnosti dovoljno dobar razlog za rutinsko koagulaciono ispitivanje u prva 24 sata nakon oštećenja mozga.
Ključne reči: Koagulacija krvi, fibrinoliza, oštećenje mozga