Anticoagulant Therapy for Symptomatic Cerebral Vasospasm

Sequential changes in coagulation activity in 45 patients with ruptured intracranial aneurysms, among whom 36 were treated with various kinds of anticoagulant agents, were measured in their acute stages. Parameters employed were prothrombin time (PT), active partial thromboplastin time (APTT), fibrinogen (FBG), platelet count (PLT), antithrombin III (AT III), plasminogen (PLG), factor V, VII, VIII, and modified thromboelastogram (Urokinase resistance test: UKRT). The values of the parameters in the most hypercoagulative stage in each patient exceeded their normal range in the following ratios: PT (longer by 1 sec) in 39 of 45, PLT (less than 12×104/μl) in 16 of 42, factor V (more than 180% or less than 75%) 2 in 12, VII (more than 120% or less than 80%) in 7 of 13, VIII (more than 140% or less than 80%) in 13 of 13, and UKRT (longer than 40 min, or shorter than 20 min) in 27 of 28. The hypercoagulative tendency of 28 patients was estimated using the disseminated intravascular coagulation (DIC) score proposed by the authors. From these estimations, 23 of the 45 patients were found to be in a DIC or pre-DIC state, that is, in DIC tendency in the authors' category. The anticoagulant agents used were divided into three groups: 1) gabexate mesilate, chondroitin sulfate, albumin, low molecular dextran, 2) heparin, and 3) aspirin. As a rule, Group 1 agents were administered to the patients with mild symptoms, and to those with severe symptoms heparin was administered besides Group 1 agents. Recently, aspirin has not been used because of the difficulty in controlling its strength of anticoagulant activity. Anticoagulant therapies were given to the non-surgical patients when they were moribund. Of 20 early surgery patients who underwent anticoagulant therapy, no patients died owing to cerebral vasospasm, though 7 of them died of other causes: preoperatively accompanying large hematoma in 3, cardiac dysfunction, troubled operation, hemorrhagic infarction in the cerebellum, and renal dysfunction, in one each. From these results, anticoagulant therapy for symptomatic vasospasm is considered to be effective.