[Detection of fibrinolysis in chronic subdural hematoma]

Various biochemical processes in hematoma fluid arising from chronic subdural bleeding have not yet been clearly explained. We examined the question whether formation of hematoma fluid after onset of bleeding is preceded by complete clotting with fibrin formation and subsequent lysis of the clot. 22 samples of hematoma fluid taken during operation were used. The protein content was 5.7 +/- 9.8 g/l (mean +/- SD), and coagulable fibrinogen could not be demonstrated whereas 0.99 +/- 0.45 mg/ml fibrin(ogen) break-down products were found immunologically. The high levels of crosslinked D-D fibrin derivatives (0.32 +/- 0.26 mg/ml) were conspicuous: there was a correspondingly high degree of crosslinking (86.2% x/- 12.2%) of the fibrin(ogen) break-down products (calculated from the proportion of dimeric to monomeric gamma-chains). Monoclonal antibodies specific for D-D were employed for the first time to answer the question. The characterization of the crosslinked fibrin derivatives together with their submolecular sub-units and the quantification of the D-D content serve to prove that fibrin is both formed and broken down in chronic subdural hematomas.