Hypercoagulability as Measured by Thrombelastography May Be Associated with the Size of Acute Ischemic Infarct—A Pilot Study

Abstract

Background: Thromboelastography (TEG®) measures coagulation function in venous blood. Previous studies have reported that this device providing an integrated data on dynamics of clot formation may be useful for predicting clinical outcome in ischemic stroke. We investigated whether a hypercoagulability detected by thrombelastography may be associated with larger size of acute ischemic infarct. Methods: We included 40 ischemic stroke subjects with large artery atherosclerosis or small-vessel disease to a cross-sectional pilot study. Thrombelastography parameters related to time of clot formation (R- reaction time, K-clot kinetics), clot growth and strengthening (angle-alpha and MA-maximum amplitude) and lysis (Ly30) were performed within first 24 h after the onset of stroke. A volume of ischemic infarct was assessed on the basis of diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging. Results: In the entire group, we reported that subjects with a large ischemic focus (>2 cm3) had a higher diameter of a clot (measured as MA) than subjects with a small ischemic focus (p = 0.0168). In the large artery atherosclerosis subgroup, we showed a significant correlation between MA and size of acute infarct (R = 0.64, p = 0.0138), between angle (alpha) and size of acute infarct (R = 0.55, p = 0.0428) and stroke subjects with hypercoagulability (MA > 69 mm) had significantly higher probability of a larger size of acute ischemic focus compared to normalcoagulable subjects (5.45 cm3 vs. 1.35 cm3; p = 0.0298). In multivariate logistic regression hypercoagulability was a predictor of a large size of ischemic infarct (Odds ratio OR = 59.5; 95% confidence interval (CI) 1.08–3558.8; p = 0.0488). Conclusions: We emphasized that thrombelastography, based on the parameters related to clot strength, may have clinical utility to identify the risk of the extensive ischemic infarct.

Clinical and Evolutionary Implications of Dynamic Coagulotoxicity Divergences in Bothrops (Lancehead Pit Viper) Venoms

“…A common haemostatic assay used in clinical settings to manage and treat patients and predict patient outcomes is thromboelastography (TEG) [ 59 , 60 , 61 , 62 ]. TEG is extremely useful for measuring blood coagulation parameters as a myriad of aspects are ascertained simultaneously, including amplitude (A) (strength of the clot) and reaction time (R) (time until clot formation), thus aiding in the diagnosis and treatment of patients admitted to hospital with coagulopathy.…”

The value of thromboelastography in evaluating the efficacy of Xueshuantong combined with edaravone in the treatment of acute cerebral infarction

“…We also predicted whether patients would have a higher risk of adverse events. [15,16] Shimei et al [17] showed that the levels of TEG-related indicators in ACI patients were higher or lower than those in healthy controls, and with the severity of the disease. Logistic regression analysis confirmed that the relevant indicators of TEG were important risk factors affecting the degree of brain injury in patients with cerebral infarction.…”

Clinical Application of Thromboelastography in Acute Ischemic Stroke

“… 53 In a cross-sectional, single-center study, higher MA and bigger α were associated with a larger size of ischemic infarct in the large artery atherosclerosis group. 55 …”

“…53 In a cross-sectional, single-center study, higher MA and bigger α were associated with a larger size of ischemic infarct in the large artery atherosclerosis group. 55 Moreover, AIS is the most common neurologic complication of coronavirus disease 2019 (COVID-19). 56,57 The incidence of AIS induced by COVID-19 ranges only from 1% to 6%, but the motility rate of 38% is relatively high.…”