Prediction of Hematoma Expansion in Patients With Intracerebral Hemorrhage Using Thromboelastography With Platelet Mapping: A Prospective Observational Study

Abstract

Background and Purpose: The purpose of the study was to evaluate the usefulness of thromboelastography with platelet mapping (TEG-PM) for predicting hematoma expansion (HE) and poor functional outcome in patients with intracerebral hemorrhage (ICH).Methods: Patients with primary ICH who underwent baseline computed tomography (CT) and TEG-PM within 6 h after symptom onset were enrolled in the observational cohort study. We performed univariate and multivariate logistic regression models to assess the association of admission platelet function with HE and functional outcome. In addition, a receiver operating characteristic (ROC) curve analysis investigated the accuracy of platelet function in predicting HE. A mediation analysis was undertaken to determine causal associations among platelet function, HE, and outcome.Results: Of 142 patients, 37 (26.1%) suffered HE. Multivariate logistic regression identified arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition as significant independent predictors of HE. The area under the ROC curves was 0.727 for AA inhibition and 0.721 for ADP inhibition. Optimal threshold for AA inhibition was 41.75% (75.7% sensitivity; 67.6% specificity) and ADP inhibition was 65.8% (73.0% sensitivity; 66.7% specificity). AA and ADP inhibition were also associated with worse 3-month outcomes after adjusting for age, admission Glasgow Coma Scale score, intraventricular hemorrhage, baseline hematoma volume, and hemoglobin. The mediation analysis showed that the effect of higher platelet inhibition with poor outcomes was mediated through HE.Conclusions: These findings suggest that the reduced platelet response to ADP and AA independently predict HE and poor outcome in patients with ICH. Platelet function may represent a modifiable target of ICH treatment.

Viscoelastic Testing in the Clinical Management of Subarachnoid Hemorrhage and Intracerebral Hemorrhage

“…Full-text screening was performed on 87 studies and of these, 24 were included for analysis. The 24 studies were then subdivided into the following: studies including (1) SAH patients prior to stenting or coiling (n ¼ 12), 14,25,[28][29][30][31][32][33][34][35][36][37] (2) ICH patients not taking anticoagulant or antiplatelet medications (n ¼ 4), 30,[38][39][40] (3) ICH patients on antiplatelet or anticoagulant medications (n ¼ 4), [41][42][43][44] (4) SAH patients undergoing stenting or coiling or ischemic stroke patients following thrombolysis or thrombectomy, developing ICH as a complication to treatment (n ¼ 5). 26,[45][46][47][48] One study contained data on both ICH and SAH patients.…”

“…Only four studies included ICH patients not taking any anticoagulant or antiplatelet medications. 30,[38][39][40] The studies by Hvas et al and Lauridsen et al partly shared cohort, 30,40 and the study by Roh et al did not include a healthy control group and did not provide a reference interval. 39 He et al applied TEG platelet mapping in 142 ICH patients, 38 but results were stratified according to clinical outcome and a reference interval was not provided.…”

“…Only the study by He et al associated findings with clinical outcome. 38 TEG platelet mapping revealed lower platelet aggregation in patients suffering from hematoma expansion and low platelet aggregation was an independent risk factor for poor outcome. However, the area under the curve of the receiver operating characteristic curve for ADP inhibition was 0.721 and for AA inhibition it was 0.727, indicating that low platelet aggregation is not a strong predictor of poor outcome.…”

Letter to the Editor Regarding “Viscoelastic Hemostatic Assays and Outcomes in Traumatic Brain Injury: A Systematic Literature Review”

“… 27 , 28 , 29 Multiple centers have also used point-of-care VHAs to predict clinically significant progression of intracranial hemorrhage after TBI. 30 , 31 , 32 , 33 …”