Abstract 34: Hypercoagulable Response After Intracerebral Hemorrhage Does Not Occur in Patients With Hematoma Enlargement
Background: Intracerebral hemorrhage (ICH) has high morbidity, and hematoma enlargement (HE) causes worse outcome. Thromboelastography (TEG) measures the dynamics of clot formation and dissolution, and might be useful for assessing bleeding risk. Speed of clot formation in minutes is measured by parameters R, K, and delta, and clot strength in dynes of resistance by MA and G. We used TEG to detect changes in clotting in patients with and without HE after ICH.
Methods: This prospective study included 64 patients with spontaneous ICH admitted from 2009 to 2013. TEG was performed within 6 hours of symptom onset and after 36 hours. Brain imaging was obtained at baseline and 36 ±12 hours, and HE defined as total volume increase > 6cc or >33%.TEG was also obtained from 57 healthy controls. Comparisons between groups were assessed by t-test or Wilcoxon rank sum tests. Multivariable regression was performed after controlling for potential confounders.
Results: Age and gender were not different between ICH patients and controls. Compared to controls, ICH patients demonstrated faster and stronger clot formation; shorter R and delta (p<0.0001) at baseline; and higher MA and G (p < 0.0001) at 36 hours. 11/64 (17%) patients had HE. Male sex and prior clopidrogel use were more frequent in the HE + group (p<0.05) compared to HE -. After controlling for potential confounders (age, clopidrogel, INR, platelet count), baseline K and delta were longer in HE + vs. HE - patients, indicating that HE+ patients had slower clot formation (p<0.05). TEG was not different between HE + and HE - patients at 36 hours.
Discussion: TEG may detect important coagulation changes in patients with ICH; clotting may become faster and stronger in immediate response to ICH; a less robust response may be associated with HE. These findings may have relevance to patient management and deserve further investigation.
Delta values at baseline for controls, all hemorrhage patients, hemorrhage enlargement (HE) + and (HE) - patients.
Author Disclosures: J. Kawano-Castillo: Research Grant; Significant; NIH SPOTRIAS P50 NS 044227, NIH T32 NS0077412-12. E. Ward: None. A. Elliott: None. J. Wetzel: None. A. Hassler: None. M. McDonald: None. S.A. Parker: None. J. Archeval-Lao: None. C. Tremont: None. C. Cai: None. M.H. Rahbar: None. J. Grotta: Research Grant; Significant; SPOTRIAS P50-NS044227.
- © 2014 by American Heart Association, Inc.