Thromb Haemost 2023; 123(12): 1180-1186
DOI: 10.1055/a-2084-5018
Stroke, Systemic or Venous Thromboembolism

Hypercoagulability on Thromboelastography Can Predict the Functional Outcomes in Patients with Acute Ischemic Stroke

1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Jae-Han Bae
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sang Hee Ha
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Bum Joon Kim
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sang-Beom Jeon
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Dong-Wha Kang
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sun U. Kwon
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Jong S. Kim
2   Department of Neurology, Gangneung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, Republic of Korea
,
Jun Young Chang
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
› Institutsangaben
Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HR18C0016).


Abstract

Background We investigated the association between the reaction time (R), a thromboelastography (TEG) parameter for hypercoagulability, and functional outcomes based on the occurrence of hemorrhagic transformation (HT) and early neurological deterioration (END).

Methods We enrolled ischemic stroke patients and performed TEG immediately after the patients' arrival. The baseline characteristics, occurrence of HT and END, stroke severity, and etiology were compared according to the R. END was defined as an increase of ≥1 point in motor or ≥2 points in the total National Institute of Health Stroke Scale within 3 days after admission. The outcome was the achievement of functional independence (modified Rankin scale [mRS]: 0–2) at 3 months after stroke. Logistic regression analyses were performed to verify the association between R and outcome.

Results HT and END were frequently observed in patients with an R of <5 minutes compared with the group with an R of ≥5 minutes (15 [8.1%] vs. 56 [21.0%], p < 0.001; 16 [8.6%] vs. 65 [24.3%], p = 0.001, respectively). In multivariable analysis, an R of <5 minutes was associated with decreased odds of achieving functional independence (0.58 [0.34–0.97], p = 0.038). This association was maintained when the outcome was changed to disability free (mRS 0–1) and when mRS was analyzed as an ordinal variable.

Conclusion Hypercoagulability on TEG (R <5 minutes) may be a negative predictor for functional outcome of stroke after 3 months, with more frequent HT, END, and different stroke etiologies. This study highlights the potential of TEG parameters as biomarkers for predicting functional outcomes in ischemic stroke patients.

Supplementary Material



Publikationsverlauf

Eingereicht: 19. Juli 2022

Angenommen: 28. April 2023

Accepted Manuscript online:
02. Mai 2023

Artikel online veröffentlicht:
30. Mai 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Mallett SV, Cox DJ. Thrombelastography. Br J Anaesth 1992; 69 (03) 307-313
  • 2 Wang H, Robinson RD, Phillips JL. et al. Traumatic abdominal solid organ injury patients might benefit from thromboelastography-guided blood component therapy. J Clin Med Res 2017; 9 (05) 433-438
  • 3 Trautman CL, Palmer WC, Taner CB. et al. Thromboelastography as a predictor of outcomes following liver transplantation. Transplant Proc 2017; 49 (09) 2110-2116
  • 4 Welsby IJ, Jiao K, Ortel TL. et al. The kaolin-activated thrombelastograph predicts bleeding after cardiac surgery. J Cardiothorac Vasc Anesth 2006; 20 (04) 531-535
  • 5 Yao X, Dong Q, Song Y, Wang Y, Deng Y, Li Y. Thrombelastography maximal clot strength could predict one-year functional outcome in patients with ischemic stroke. Cerebrovasc Dis 2014; 38 (03) 182-190
  • 6 Shi Z, Zheng WC, Fu XL, Fang XW, Xia PS, Yuan WJ. Hypercoagulation on thromboelastography predicts early neurological deterioration in patients with acute ischemic stroke. Cerebrovasc Dis 2018; 46 (3-4): 125-131
  • 7 Yu G, Kim YJ, Jeon SB, Kim WY. Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke. Am J Emerg Med 2020; 38 (09) 1772-1777
  • 8 Nam KW, Kim CK, Kim TJ. et al. D-dimer as a predictor of early neurologic deterioration in cryptogenic stroke with active cancer. Eur J Neurol 2017; 24 (01) 205-211
  • 9 Hacke W, Kaste M, Fieschi C. et al; Second European-Australasian Acute Stroke Study Investigators. Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Lancet 1998; 352 (9136): 1245-1251
  • 10 Lee JH, Park KY, Shin JH. et al. Symptomatic hemorrhagic transformation and its predictors in acute ischemic stroke with atrial fibrillation. Eur Neurol 2010; 64 (04) 193-200
  • 11 Elliott A, Wetzel J, Roper T. et al. Thromboelastography in patients with acute ischemic stroke. Int J Stroke 2015; 10 (02) 194-201
  • 12 Folsom AR, Gottesman RF, Appiah D, Shahar E, Mosley TH. Plasma d-Dimer and incident ischemic stroke and coronary heart disease: The Atherosclerosis Risk in Communities Study. Stroke 2016; 47 (01) 18-23
  • 13 Barber M, Langhorne P, Rumley A, Lowe GD, Stott DJ. Hemostatic function and progressing ischemic stroke: D-dimer predicts early clinical progression. Stroke 2004; 35 (06) 1421-1425
  • 14 Csala M, Léránt I, Bánhegyi G. et al. Prostaglandin-independent stimulation of interleukin-6 production by fibrinogen degradation product D in perfused murine liver. Scand J Immunol 1998; 48 (03) 269-271
  • 15 Urbach H, Hartmann A, Pohl C. et al. Local intra-arterial thrombolysis in the carotid territory: does recanalization depend on the thromboembolus type?. Neuroradiology 2002; 44 (08) 695-699
  • 16 Tan S, Wang D, Liu M, Zhang S, Wu B, Liu B. Frequency and predictors of spontaneous hemorrhagic transformation in ischemic stroke and its association with prognosis. J Neurol 2014; 261 (05) 905-912
  • 17 Tu HT, Campbell BC, Christensen S. et al; EPITHET-DEFUSE Investigators. Worse stroke outcome in atrial fibrillation is explained by more severe hypoperfusion, infarct growth, and hemorrhagic transformation. Int J Stroke 2015; 10 (04) 534-540
  • 18 Terruso V, D'Amelio M, Di Benedetto N. et al. Frequency and determinants for hemorrhagic transformation of cerebral infarction. Neuroepidemiology 2009; 33 (03) 261-265
  • 19 Zhang J, Yang Y, Sun H, Xing Y. Hemorrhagic transformation after cerebral infarction: current concepts and challenges. Ann Transl Med 2014; 2 (08) 81
  • 20 Seners P, Baron JC. Revisiting ‘progressive stroke’: incidence, predictors, pathophysiology, and management of unexplained early neurological deterioration following acute ischemic stroke. J Neurol 2018; 265 (01) 216-225
  • 21 Xuan J, Wang J, Wei B. Diagnostic value of thromboelastography (TEG) for the diagnosis of death in infected patients. Clin Appl Thromb Hemost 2021; 27: 1-11
  • 22 Shi Z, Zheng WC, Yang H, Fu XL, Cheng WY, Yuan WJ. Contribution of dehydration to END in acute ischemic stroke not mediated via coagulation activation. Brain Behav 2019; 9 (06) e01301