Increased plasma plasmin-α2-plasmin inhibitor complex levels correlate with postoperative rebleeding after endoscopic surgery for spontaneous intracerebral hemorrhage.
BACKGROUND
Postoperative rebleeding (PR) is one of the most severe complications of endoscopic surgery, often performed to remove spontaneous intracerebral hemorrhage (sICH). However, the risk factors for PR remain unclear.


OBJECTIVE
This study retrospectively investigated whether increased preoperative plasma plasmin-α2-plasmin inhibitor complex (PIC) levels, indicating activation of fibrinolysis, are associated with PR.


METHODS
A total of 101 patients underwent endoscopic surgery to evacuate sICH at our institution from January 2010 to June 2019, and 79 patients who underwent examinations of plasma PIC levels at admission with available radiographical data were included. Correlations between PR and increased plasma PIC levels were retrospectively evaluated.


RESULTS
PR occurred in eight patients (10.1%), and high PIC levels (≥ 4 or 6 μg/ml) were significantly associated with PR. The sensitivities employing high PIC levels of ≥ 4 μg/ml and ≥ 6 μg/ml were both 0.63, and the specificities using the same PIC levels were 0.86 and 0.92, respectively. Multivariable analyses showed that high plasma PIC levels of ≥ 4 μg/ml (odds ratio (OR), 12.77; 95% confidence interval (CI), 1.65-98.77; p = 0.02) or ≥ 6 μg/ml (OR, 18.33; 95% CI, 2.32-144.82; p = 0.006) were independent predictors of PR.


CONCLUSIONS
This study found that increased plasma PIC levels were associated with PR following the endoscopic evacuation of sICHs, indicating that increased plasma PIC levels could be potentially used to predict PR. Further studies are needed to establish new surgical strategies and adjuvant treatments to improve surgical outcomes in patients with sICH prone to PR.
['Yagi|Kenji|K|', 'Tao|Yoshifumi|Y|', 'Hara|Keijirou|K|', 'Kanda|Eiichiro|E|', 'Hirai|Satoshi|S|', 'Takai|Hiroki|H|', 'Kinoshita|Keita|K|', 'Mimani|Yukari|Y|', 'Miyazaki|Yuko|Y|', 'Oyama|Naoki|N|', 'Yagita|Yoshiki|Y|', 'Matsubara|Shunji|S|', 'Uno|Masaaki|M|']
D000368:Aged D002543:Cerebral Hemorrhage D005260:Female D005341:Fibrinolysin D005342:Fibrinolysis D006801:Humans D008297:Male D008875:Middle Aged D044583:Neuroendoscopy D011183:Postoperative Complications D011184:Postoperative Period D012189:Retrospective Studies D012307:Risk Factors D000979:alpha-2-Antiplasmin
Plasmin-α2-plasmin inhibitor complex Rebleeding Endoscopic surgery Intracerebral hemorrhage Fibrinolysis