Fibrinogen and D-dimer analysis of chronic subdural hematomas and computed tomography findings: A prospective study

Objective: We investigated the relationship between fibrinolytic factors and computed tomography (CT) findings in patients with chronic subdural hematomas (CSDHs). Methods: Thirty-one patients with CSDHs were divided on the basis of CT findings into heterogeneous and homogeneous groups. A sample from the subdural hematoma was obtained at surgery to measure the concentrations of fibrinogen and D-dimer. Results: The mean level of fibrinogen in the heterogeneous group, including the layering (n = 4) and mixed (n = 10) type, was 88.2 +/- 121.2 mg/dL, whereas in the homogeneous group, including high density (n = 2), isodensity (n=9), and low density (n=6) types, it was <25 mg/dL. The concentration of fibrinogen was significantly higher in the heterogeneous group than in the homogeneous group (p=0.006). The mean level of D-dimer in the heterogeneous group was 35,407.9 +/- 16,325.5 mu g/L, whereas for the homogeneous group it was 1476.4 +/- 2091.4 mu g/L. The concentration of D-dimer was significantly higher in the heterogeneous group than in the homogeneous group (p<0.001). Conclusions: The layering and mixed types of CSDH exhibited higher concentrations of fibrinogen and D-dimer in subdural hematoma than the homogeneous types. These fibrinolytic factors appear to be associated with evolution in CSDHs with heterogeneous density. (C) 2010 Elsevier B.V. All rights reserved.