Fibrinolyse Precoce Avec Elevation Des Produits De Degradation Du Fibrinogene Dans L\'hematome Intra Cerebral Spontane

Abstract

Description L\'hematome intracerebral est essentiellement considere comme une maladie vasculaire, liee a la structure des vaisseaux. Un traitement recent, le facteur VII, a montre indirectement l\'importance de l\'hemostase dans cette affection. Objectif Explorer certains aspects de l\'hemostase dans une serie d\'hematomes intra-cerebraux spontanes. Methode : Des tests d\'hemostase ont ete realises chez des patients porteurs d\'un hematome intra-cerebral spontane. Les taux de fibrinogene et des produits de degradation de fibrinogene (PDF) ont ete doses a l\'entree, tandis que la numeration des thrombocytes, l\'International Normalized Ratio (INR), le temps de cephaline activee (TCA) ont ete par ailleurs determines. Resultats Treize patients successifs ont ete etudies. Chez 3 patients, une elevation des facteurs de degradation du fibrinogene a ete observee (3/13 soit 23%). Un cas de thrombopenie associee a l\'augmentation des PDF a ete note. Conclusion Dans un sous-groupe non negligeable d\'hematomes, il existe une fibrinolyse concomitante dans les 24 premieres heures. Ce phenomene est soit primitif, soit secondaire a la rupture vasculaire. Background Intracerebral haematoma is considered as an essentially vascular disease related to the structure of vessels. A recent treatment, VII factor has indirectly shown the importance of haemostasis in this ailment. Objective explored certain aspects of haemostasis in a series of intracerebral spontaneous haematomas. Method Haemostasis tests have been achieved among patients with a spontaneous intracerebral haematoma. The rate of fibrinogen and fibrinogen degradation products (FDP) have been measured at the admission, while the count of thrombocyts, and INR and ACT have also been determined. Results Thirteen successive patients have been studied. In three patients, an elevation of fibrinogen degradation factors has been observed (3/13 or 23%). A case of thrombopenia associated with the increase of FDP has been recorded. Conclusion In a considerable subgroup of haematomas, one could observe a concomitant fibrinolysis during the first 24 hours. This phenomenon is either initial or secondary to a vascular rupture. Keywords : fibrinolysis, fibrinogen, intracerebral haematoma, haemostasis, thrombopenia, thrombocyts African Journal of Neurological Sciences Vol. 27 (1) 2008: pp. 16-20