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Thromb Haemost 2017; 117(04): 691-699
DOI: 10.1160/TH16-11-0834
Coagulation and Fibrinolysis
Schattauer GmbH

Plasma ADAMTS13 activity and von Willebrand factor antigen and activity in patients with subarachnoid haemorrhage

Monisha Kumar   *
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Wenjing Cao   *
2   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Jenny K. McDaniel
2   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Huy P. Pham
2   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Dheeraj Raju
3   Department of Acute, Chronic, and Continuing Care, The University of Alabama at Birmingham, Birmingham, Alabama, USA
,
Kelsey Nawalinski
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Suzanne Frangos
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
David Kung
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Eric E. Zager
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Scott E. Kasner
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
Joshua M. Levine
1   Departments of Neurology, Neurosurgery, & Anesthesiology & Critical Care, The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
,
X. Long Zheng
2   Division of Laboratory Medicine, Department of Pathology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
› Author Affiliations
Further Information

Publication History

Received: 09 November 2016

Accepted after major revision: 15 January 2016

Publication Date:
28 November 2017 (online)

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Summary

Increased von Willebrand factor (VWF) and reduced ADAMTS13 activity are associated with arterial thrombosis. This may also be the culprit mechanism implicated in delayed cerebral ischaemia after aneurysmal subarachnoid haemorrhage (SAH). It was our objective to determine plasma VWF and ADAMTS13 in patients with SAH and healthy subjects; and to explore the levels of those markers and outcome after SAH. Forty consecutive patients were enrolled between September 2007 and April 2014 in a pilot study. Plasma samples were collected from SAH patients on post-bleed day (PBD) 0, 1, 3, 5, 7 and 10 and healthy controls. VWF antigen (VWFAg) and VWF activity (VWFAc) were determined by enzyme-linked immunoassay and collagen binding assay, respectively. ADAMTS13 activity was determined by the cleavage of a fluorescent substrate. Univariate descriptive statistics and cluster analyses were performed based on outcomes in the group with SAH only. Mean age of SAH patients was 52.4 years (26–84 years) and 30 (75 %) were women. 12/40 (30 %) had a high Hunt and Hess grade (IV-V) and 25 (62.5 %) were treated with coil embolisation. Plasma VWFAg and VWFAc were significantly higher in SAH patients than those in healthy subjects on each PBD (p<0.0001). Concurrently, plasma ADAMTS13 activity in SAH patients was significantly lower than that in healthy subjects (p<0.0001). Among those with SAH, cluster analysis demonstrated that patients with higher VWFAg and VWFAc and/or lower ADAMTS13 activity might be at risk of increased mortality. In conclusion, the relative deficiency of plasma ADAMTS13 activity in SAH patients may associate with worse outcome.

Keywords

Subarachnoid haemorrhage - delayed cerebral ischaemia - von Willebrand factor - ADAMTS13 - platelet hypercoagulability - microvascular thrombosis - and brain aneurysm

* Contributed equally to this work.


 

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