http://link.springer.com/article/10.1007/s12975-014-0377-3
Abstract
Little is known about the
pathophysiology of oral anticoagulation-associated intracerebral
hemorrhage (OAC-ICH). We compared hematoma volume, number of terminal
deoxynucleotidyl dUTP nick-end labeling (TUNEL)-positive cells (indicating cell death), MMP-9
levels, and perilesional edema formation between warfarin-treated mice
and controls. Intracerebral hemorrhage was induced by an injection of
collagenase into the right striatum. Twenty-four hours later, hematoma
volume was measured using a photometric hemoglobin assay. Cell death was
quantified using TUNEL staining. MMP-9 levels were determined by zymography, and edema formation was assessed via the wet–dry method. Warfarin increased hematoma volume by 2.6-fold. The absolute number of TUNEL-positive cells in the perihematomal zone was lower in warfarin-treated animals (300.5 ± 39.8 cells/mm2) than in controls (430.5 ± 38.9 cells/mm2; p = 0.034), despite the larger bleeding volume. MMP-9 levels were reduced in anticoagulated mice as compared to controls (p
= 0.018). Perilesional edema formation was absent in warfarin mice and
modestly present in controls. Our results suggest differences in the
pathophysiology of OAC-ICH compared to intracerebral hemorrhage
occurring under normal coagulation. A likely explanation is that
thrombin, a strong inductor of apoptotic cell death and blood–brain
barrier disruption, is produced to a lesser extent in OAC-ICH. In
humans, however, we assume that the detrimental effects of a larger
hematoma volume in OAC-ICH by far outweigh potential protective effects
of thrombin deficiency.
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