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71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

21.06. - 24.06.2020

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Perihematomal thrombin expression is initiated in the early phase after intracerebral hemorrhage and correlates with worse neurological outcome in patients with ICH

Perihematomal thrombin expression is initiated in the early phase after intracerebral hemorrhage and correlates with worse neurological outcome in patients with ICH

Meeting Abstract

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  • presenting/speaker Harald Krenzlin - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
  • Beat Alessandri - Universitätsmedizin Mainzeorg-August-Universität Göttingen, Institut für Neurochirurgische Pathophysiologie, Göttingen, Deutschland
  • Julia Masomi-Bromwasser - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
  • Christina Frenz - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
  • Thomas Kerz - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
  • Oliver Kemspki - Universitätsmedizin Mainzeorg-August-Universität Göttingen, Institut für Neurochirurgische Pathophysiologie, Göttingen, Deutschland
  • Florian Ringel - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland
  • Naureen Keric - Universitätsmedizin Mainz, Neurochirurgische Klinik, Mainz, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 71. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 9. Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. sine loco [digital], 21.-24.06.2020. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocBO-03

doi: 10.3205/20dgnc021, urn:nbn:de:0183-20dgnc0219

Veröffentlicht: 26. Juni 2020

© 2020 Krenzlin et al.
Dieser Artikel ist ein Open-Access-Artikel und steht unter den Lizenzbedingungen der Creative Commons Attribution 4.0 License (Namensnennung). Lizenz-Angaben siehe http://creativecommons.org/licenses/by/4.0/.

Gliederung

Text

Objective: Spontaneous intracerebral hemorrhage (ICH) is a leading cause of disability and mortality. Thrombin induces brain edema and neuronal death. However, whether the perihematomal thrombin is generated by a local cerebral thrombin system or washed in from circulation, is still unknown. In our study, we utilize a unique mouse model (1) as well as cerebrospinal fluid (CSF) samples of patients with ICH (2).

Methods:

1.
Prothrombin expression was analyzed using quantitative RT-PCR 4h and 24h after ICH in our mouse model. Further, perihematomal thrombin concentration 24h after ictus was measured using immunohistology. The neurological outcome was assed using the Rotarod performance test.
2.
Blood and CSF samples were obtained from 12 patients with ICH (7 male, 5 females; mean age 65+-2 years) and 2 controls (both male) on days 1 and 3. Factor IIa was analyzed using enzyme-linked immunosorbent assay. Clot volumes were determined based on computed tomography and neurological outcome was determined 6 weeks after ICH onset using the modified Rankin Scale.

Results:

1.
Animals receiving blood injections showed a 4.24+-.0.5 (P < 0.05) fold increase in thrombin concentrations 24h after ICH. Prothrombin transcription was increased 4h after ICH and decreased of the course of 24h (4.7+-1.6 fold; P < 0.05). Elevated thrombin concentrations correlate with detrimental neurological outcome (sham: 72+-.8.85sec, blood: 3.5+-.95).
2.
CSF thrombin concentrations are likewise elevated after ICH (P < 0.05) compared to controls. The thrombin concentration does not correlate with the initial clot size (r2 = 0.21, p = 0.15) or the presence of intraventricular hemorrhage. However, increasing thrombin concentration in CSF correlate with a detrimental neurological outcome 6 weeks after onset of ICH (r2 = 0.5, p < .05).

Conclusion: Our study strengthens the importance of thrombin as contributor to secondary injury after ICH and as potential target for future pharmacotherapy.