Altered fibrin clot phenotype in young adults with intracerebral hemorrhage of unknown cause: A case-control study

• Published in: Thrombosis research Vol. 240; p. 109062
• Main Authors: Łopatka, Paweł, Błaż, Michał, Nowicki, Grzegorz, Undas, Anetta
• Format: Journal Article
• Language: English
• Published: United States Elsevier Ltd 01-08-2024
• Subjects: Coagulation factors; Fibrin clot properties; Intracerebral hemorrhage; Stroke in the young; Fibrin clot properties; Coagulation factors; Stroke in the young; Intracerebral hemorrhage
• ISSN: 0049-3848; 1879-2472; 1879-2472
• DOI: 10.1016/j.thromres.2024.109062

Intracerebral hemorrhage (ICH) of undetermined etiology occurs infrequently in young and middle-aged adults. We hypothesized that slight decreases in coagulation factors and formation of less compact fibrin clots prone to faster lysis predispose to this type of ICH.
We recruited 44 consecutive patients aged <50 years following ICH of unknown cause at least 3 months since the event. Subjects free of ICH (n = 47) matched for age, sex, BMI, and hypertension served as the control group. We assessed plasma fibrin clot permeability, turbidity and fibrinolytic capacity, along with thrombin generation, coagulation factors (F) II, FV, FVII, FVIII, FIX, FX, FXI, antithrombin, and fibrinolysis proteins.
ICH patients (median age 41 years, 45.5 % women) had 8.4 % lower FII (p = 0.0001) and 10.1 % lower FVII activity (p = 0.0003), 9.4 % higher antithrombin activity (p = 0.0004) and 13.5 % lower platelet count (p = 0.02). Other factors and thrombin generation did not differ between the two groups. The ICH survivors were characterized by impaired fibrin polymerization reflected by 10.1 % longer lag phase of the turbidimetry curve (p = 0.0002), decreased fiber density indicated by 11.8 % lower maximum absorbance (p = 0.004), as well as 11.1 % shorter clot lysis time (p = 0.014) and 10.0 % faster increase of maximal D-Dimer levels (p = 0.000001).
We demonstrated a prohemorrhagic fibrin clot phenotype, along with lower FII, FVII and higher antithrombin activity in adults below 50 years of age who suffered from ICH of unknown cause, which might indicate novel mechanisms contributing to ICH in younger individuals.
•Intracerebral hemorrhage (ICH) of undetermined etiology occurs infrequently in young (under 50) Patients.•We observed a prohemorrhagic fibrin clot phenotype, lower FII, FVII and higher antithrombin activity in this group.•Slight decreases in coagulation factors and formation of less compact clots prone to faster lysis predispose to ICH.•Detected irregularities might indicate novel mechanisms contributing to ICH in younger individuals.