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-alpha 2-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 mu g/ml) were significantly associated with PR. The sensitivities employing high PIC levels of >= 4 mu g/ml and >= 6 mu g/mlwere 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 mu g/ml (odds ratio (OR), 12.77; 95% confidence interval (CI), 1.65-98.77; p = 0.02) or = 6 mu g/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.