Clinical Application of Thromboelastography in Acute Ischemic Stroke

Abstract

Acute ischemic stroke (AIS), characterized by high morbidity and mortality, has imposed a considerable burden on society. Despite rapid development in the treatment of AIS, there is still a high risk of recurrence. Furthermore, there is a time delay in waiting for the results of conventional coagulation tests in candidate patients for intravenous thrombolysis therapy. Heterogeneous responses to antiplatelet, intravascular thrombolysis, and endovascular therapies also worsen the situation. Thromboelastography (TEG), as a global and portable detection method for hemostasis, facilitates clinicians in disease monitoring, treatment evaluation, and prognosis prediction in AIS. In this narrative review, we provided a comprehensive summary of the clinical application of TEG in ischemic stroke and gave insights to further studies.

Comparison of D‐dimer concentration and thromboelastography for diagnosis of cerebrovascular accidents in dogs: A retrospective study

“…The human medical literature indicates that changes in TEG are consistent with hypercoagulability in patients with ischemic stroke and may have some predictive value for classifying ischemic vs hemorrhagic strokes. [21][22][23] Patients diagnosed with ischemic CVAs were more likely to have TEG changes consistent with hypercoagulability, and certain parameters (K value, angle) reflected severity of cerebral infarction. 21 Additionally, parameters such as an R value <5 minutes were associated with increased risk of hemorrhagic transformation of acute ischemic stroke.…”

“…People diagnosed with cerebral hemorrhage most often had evidence of a hypocoagulable state, although some individuals had results suggesting a hypercoagulable state 21 . Thromboelastography also may be used to guide and monitor response to thrombolytic, antiplatelet, and anti‐coagulant treatment 23 . We were unable to assess for an association between hemorrhagic CVAs and hypocoagulability because no dogs had TEG results consistent with hypocoagulability, and TEG changes in response to anti‐stroke treatment also were not assessed.…”

“…Abnormalities in TEG can provide evidence for hypercoagulable states that may predispose to thromboembolic events, as well as for hypocoagulable states or platelet dysfunction. 13 Although D-dimers and TEG have been used to aid in diagnosing CVAs in human patients, [14][15][16][17][18][19][20][21][22][23] studies evaluating D-dimers and TEG for aiding CVA diagnosis in animals are limited. 24,25 The diagnosis of CVA in dogs is challenging because of lack of pathognomonic test results and limited accessibility to MRI.…”

Chinese expert consensus on anti-thrombotic therapy for pan-vascular diseases (2023 edition)

“…There are effects on a number of parameters, mainly including prolonged R time, prolonged K time, and reduced maximum amplitude [127][128] Maximum controlled study has shown that, for patients experiencing intracerebral hemorrhage while on anti-thrombotic therapy, resuming antiplatelet therapy has only a minor impact on the risk of recurrent intracerebral hemorrhage. However, the secondary prevention benefits of antiplatelet therapy far outweigh the risks of intracerebral hemorrhage [132] .…”

Hypercoagulability State in Predicting Severe Functional Outcome in Patients with Acute Ischemic Stroke: Cause, Consequence, or Both?

“…Acute ischemic stroke might be associated with hypercoagulability in approximately 30 to 40% of these patients. 1 2 This association could be explained by the fact that the exposure of collagen in damaged vessels triggers a cascade of coagulation factors which therein forms the emboli that can occlude cerebral arteries. 3 Hypercoagulability could also be involved in early neurological deterioration which occurs in approximately 20 to 30% of patients following acute ischemic stroke.…”