Fibrin-fibrinogen degradation products in cerebrospinal fluid of patients admitted to a psychiatric unit

Proteome Study of Human Cerebrospinal Fluid following Traumatic Brain Injury Indicates Fibrin(ogen) Degradation Products as Trauma-Associated Markers

Traumatic brain injury (TBI), like other central nervous system pathologies, causes changes in the composition of cerebrospinal fluid (CSF). Consequently analysis of the CSF components is important to better understand the pathological processes involved in such diseases. The aim of this work was to identify specific markers of severe TBI. Proteomic analysis including two-dimensional gel electrophoresis combined with mass spectrometry analysis was used to compare the CSF protein profile of severe TBI patients and controls. Proteins (alpha 1 antitrypsin, haptoglobin 1 alpha1, alpha2, and beta) belonging to the acute phase response showed an increased expression in severe TBI patients. Two other proteins, identified as proteolytic degradation products of the carboxyl-terminal portion of the fibrinogen beta, were present only in TBI patients. The presence of these markers could correlate with a post-traumatic local increase in fibrinolysis as well as to an inflammatory event following CNS tissue injury.

Effect of fibrin-fibrinogen degradation products on human basilar artery preparations

Experiments were performed to determine the effects of fibrin-fibrinogen degradation products on the human basilar artery in vivo. Citrated plasma and streptokinase were incubated at 37 degrees C to produce a preparation of fibrinogen degradation products. Aliquots of the incubate were obtained at 90 minutes, 48 hours, and 1 and 2 weeks after preparation, and were separated into fractions of different molecular weight (MWt), using an ultrafiltration technique. Each fraction was tested at each of the above times for contractile activity and possible interaction with a threshold concentration of 5-hydroxytryptamine (5-HT) on the human basilar artery. Contractile activity was initially confined to the 90-minute aliquot fraction MWt greater than 100,000, but as the incubation proceeded, such activity was also seen in the lower MWt fraction less than 100,000 greater than 10,000 at all time intervals. This activity was never seen in the fraction MWt less than 10,000 at any time. Enhancement of the 5-HT response was initially confined to the higher molecular weight fractions, but after 48-hour incubation all fractions showed this activity. It is suggested that products of fibrin-fibrinogen degradation may be involved directly or indirectly in influencing the pathophysiological mechanism(s) responsible for cerebral arterial spasm following subarachnoid hemorrhage.

Fibrin-fibrinogen degradation products in cerebrospinal fluid as an indicator of neonatal brain damage

The occurrence of brain damage in 57 full term neonates was investigated. The infants were submitted to a prospective protocol involving clinical (neurological and electroencephalographical) and biological examinations, including the determination of the fibrin-fibrinogen degradation products in the blood and cerebrospinal fluid on D1, D3, D8 and D15. Psychomotor events were followed up for a year. Traumatic lumbar taps did not disturb the results significantly. Blood samples were not found to contain noticeable amounts of FDP. Conversely, the existence of FDP in CSF was not infrequent near to delivery and was shown to be closely related to brain damage as evaluated by the psychomotor events.

Coagulation and fibrinolysis in blood and cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: effect of tranexamic acid (AMCA)

Serial assays of blood coagulation factors as well as of fibrin/fibrinogen degradation products (FDP) and plasminogen activatory activity (PA) on fibrin plates in blood and cerebrospinal fluid (CSF) were performed in 41 consecutive patients with recently ruptured cerebral aneurysms, 21 of whom were randomly treated with tranexamic acid (AMCA). Coagulation factors were unaffected by the drug and plasminogen and FDP decreased in blood after two weeks' treatment. After one week, PA in CSF was increased in control patients and unchanged in AMCA-treated patients, whereas CSF-FDP had decreased among AMCA-treated patients. After two weeks PA as well as FDP in CSF showed the same values in both groups. An increase in CSF-FDP occurred after rebleeding and in patients with cerebral ischaemic symptoms. The results indicate that AMCA inhibits local fibrinolysis in CSF in patients with aneurysm rupture.

Monitoring fibrinolytic activity in the cerebrospinal fluid after aneurysmal subarachnoid haemorrhage: a guide to the risk of rebleeding?

Serial assay of fibrin degradation products (FDPs) was used to monitor fibrinolytic activity in blood and cerebrospinal fluid (CSF) after subarachnoid haemorrhage (SAH) in 64 patients, 43 of whom had aneurysms. CSF levels fell rapidly from high initial values over a few days, thereafter more slowly to reach normal levels after one to six weeks. Probably only the later slow decline is a measure of fibrinolysis, which is obscured in the first few days by the cross antigenicity with FDP's of fibrinogen released by the bleed. After this phase of fibrinogen clearance, early attainment of normal FDP levels appears to be associated with a lower risk of rebleeding in cases of aneurysm. This phenomenon could be useful in deciding whether marginal cases should be treated surgically or conservatively.

Coagulation and fibrinolytic activity of cerebrospinal fluid

Fibrin/fibrinogen degradation products (fragments D and E) were detected in cerebrospinal fluid in 23.4% of 252 patients admitted to a neurological/neurosurgical unit. Other coagulation proteins of low molecular weight (plasminogen and factor IX) were also present but larger proteins (fibrinogen and factor V) were not. These findings are consistent with protein leakage across a blood-CSF barrier damaged by inflammatory, vascular, or neoplastic disease. Fibrin/fibrinogen degradation products in cerebrospinal fluid after subarachnoid haemorrhage may not, therefore, be a reliable index of increased fibrinolytic activity in the subarachnoid space and may be misleading when selecting patients for fibrinolytic blockade.

Thrombosis and intravascular coagulation

Stress, including trauma and sepsis, is associated with a state of hypercoagulability. In these circumstances the patient is at risk of generalized or local thrombotic complications. New laboratory investigative procedures facilitate diagnosis and permit improved assessment of therapy, which at present remains of unproven efficacy both in the general and local situation.

Fibrin-fibrinogen degradation products in cerebrospinal fluid

An increase in low molecular weight fibrin-fibrinogen degradation products (FDP) was demonstrated in cerebrospinal fluid (CSF) from 17 of 18 patients with bacterial or viral meningitis compared with 29 patients without meningitis. The CSF also showed an increase in coagulation proteins of molecular weight less than 90000 (factors VII, IX, and plasminogen) but did not contain fibrinogen (MW 340000) or plasminogen activator. It is concluded that low molecular weight FDP in the CSF in infective meningitis result from leakage through a damaged blood-CSF barrier rather than from local digestion of fibrin deposited on the meninges.