Prospective Evaluation of Blood Coagulability and Effect of Treatment in Patients with Stroke Using Rotational Thromboelastometry

Stanford, SN; Sabra, Ahmed; Lawrence, Matthew; Morris, Roger H. K.; Storton, Sharon; Wani, Mushtaq Ahmad; Hawkins, Karl; Williams, P. R.; Potter, John F.; Evans, P A

doi:10.1016/j.jstrokecerebrovasdis.2014.08.028

Cited by 10 publications

(4 citation statements)

References 35 publications

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“…According to the present research so far, however, its usefulness to detect hypercoagulability or therapy resistance might be questionable in the ischemic stroke patient population. In a study involving 72 patients with ischemic stroke and 71 healthy subjects, the ROTEM method did not seem to be able to detect a hypercoagulable state in patients with ischemic stroke as compared to controls (67). Moreover, in another study involving 171 acute ischemic stroke patients treated with rt-PA, no robust association was found between TEG results and clinical response to therapy.…”

Section: Fibrinolytic Parameters/markers Of Fibrinolysis Associated Wmentioning

confidence: 99%

Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

et al. 2019

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Intravenous administration of recombinant tissue plasminogen activator (rt-PA) has been proven to be safe and effective in the treatment of acute ischemic stroke. Little is known, however, why this treatment is less effective in some patients while in others life-threatening side-effects, e.g., symptomatic intracerebral hemorrhage might occur. Clinical failure of thrombolysis related to absent or partial recanalization or reocclusion as well as hemorrhagic complications of thrombolysis are possibly related to hemostatic events. Data on markers of coagulation and/or fibrinolysis in acute stroke patients are numerous and may provide indications regarding therapy outcomes. Better understanding of the hemostatic and fibrinolytic system during rt-PA therapy might be clinically useful and ultimately might lead to an improvement in the efficacy or safety of this treatment. Studies on thrombus composition retrieved from cerebral arteries may also advance our knowledge and provide a key to improve acute stroke therapy. Here we provide a comprehensive review on a wide range of factors and markers of coagulation and fibrinolysis that have been studied in the context of thrombolysis outcome in ischemic stroke patients. Moreover, a brief summary is given on the most recent research on thrombus composition having a potential influence on outcomes.

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Section: Fibrinolytic Parameters/markers Of Fibrinolysis Associated Wmentioning

confidence: 99%

Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

et al. 2019

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“…ROTEM/TEG allows rapid in vitro dynamic and global evaluation of hemostasis. Additionally, it represents a rapid, portable, and veri ed method for physicians and may obviate thrombotic tendency undetectable in routine coagulation tests in various settings [8,21]. In this study, we simply measured brinogen levels and thrombocyte counts probably responsible for the pathogenesis of thrombosis in thyroid diseases, and made a global assessment by incorporating many factors regarding hemostasis using ROTEM/TEG for the rst time in the literature.…”

Section: Discussionmentioning

confidence: 99%

Does the Tendency to Thrombosis Increase in Autoimmune Thyroid Dysfunction? Rotational Thromboelastometric Analysis

Cansu

Taskiran

Teke

2022

Preprint

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The tendency for thrombosis is a well-known issue in hyperthyroidism, and the tendency for both bleeding and thrombosis has been shown in hypothyroidism. In the study, we aimed to establish the tendency to thrombosis by evaluating the coagulation system in thyroid diseases using thromboelastography (TEG). Thirty patients with new-onset autoimmune-based hypothyroidism, 30 with hyperthyroidism and 30 healthy volunteer subjects were enrolled in this study. Complete blood count, prothrombin time, activated partial thromboplastin time, fibrinogen levels and rotational thromboelastography (ROTEM) were studied. In the ROTEM/TEG analysis, coagulation time (CT), coagulation formation time (CFT) and maximum clot firmness (MCF) were measured. Short CT and/or CFT and/or long MCF were presumed as the tendency to hypercoagulability. The mean age of subjects with hyperthyroidism and hypothyroidism was 46±15.9 years and 44.8±13 years, respectively. The thrombocyte count in the hypothyroid group and both thrombocyte counts and fibrinogen levels in the hyperthyroid group was significantly higher than in the healthy group (p=0.004, p=0.001, p<0.001, respectively). According to ROTEM/TEG results, higher mean MCF figures were noted in both the hypo- and hyperthyroid groups compared with the healthy group (p=0.014 (hypothyroid vs. healthy groups), p=0.020 (hyperthyroid vs. healthy groups)). We showed a tendency for thrombosis using ROTEM in patients with both hyper- and hypothyroidism without thrombosis. The correlation between ROTEM/TEG parameters and the main components of thrombosis formation (thrombocyte count and fibrinogen level) indicate that the main factor might be inflammation (autoimmunity), apart from thyroid hormone levels.

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“…Efforts should certainly be directed towards these, rather than viscoelastic tests. A small study of 143 subjects using the ROTEM found no difference in coagulation and fibrinolysis parameters between patients and controls or between fibrinolytic status and stroke severity 47 . In a study of 171 patients with ischaemic stroke, a blood draw for assessment by TEG was taken before and 10 minutes after administration of t‐PA 48 .…”

Section: Assessment Of Fibrinolysis In Relation To the Prediction Of Arterial Thrombotic Eventsmentioning

confidence: 99%

Endogenous fibrinolysis—Relevance to clinical thrombosis risk assessment

Kanji

Kubica

Navarese

et al. 2020

Eur J Clin Investigation

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The development of an obstructive luminal thrombus is pathological and considered a failure of endogenous fibrinolysis. The consequences may be fatal, or result in lasting downstream organ damage. Therefore, assessment of endogenous fibrinolytic status in an individual may identify those at risk of occlusive thrombus formation and provide prognostic information. Arterial thrombi are more platelet rich and more resistant to fibrinolysis than venous thrombi. Several recent studies using global tests of fibrinolysis in patients with acute coronary syndromes (ACS) have shown that despite dual antiplatelet therapy, patients with impaired fibrinolytic status have an increased risk of adverse cardiovascular events, compared with those with effective fibrinolytic function. Such data add significantly to the predictive value of established cardiovascular risk factors and conventional biomarkers. Most data reported have been obtained with the Global Thrombosis Test and the turbidimetric plasma clot lysis assay. A few small studies in patients with ischaemic stroke suggest a similar predictive role of fibrinolytic status assessment in these patients. Studies reporting an association between impaired fibrinolysis and future venous thrombotic events are limited, and in the form of case‐control studies. Viscoelastic assays may have a role in the prediction of venous thromboembolic risk. Assays of fibrinolytic function should be used to obtain a more accurate risk of future thrombotic events, particularly in the setting of ACS. The availability of point‐of‐care tests helps facilitate this and should encourage future studies to assess personalised antithrombotic treatment combinations to optimise fibrinolytic status and reduce thrombosis risk.

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Prospective Evaluation of Blood Coagulability and Effect of Treatment in Patients with Stroke Using Rotational Thromboelastometry

Cited by 10 publications

References 35 publications

Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

Markers of Coagulation and Fibrinolysis Predicting the Outcome of Acute Ischemic Stroke Thrombolysis Treatment: A Review of the Literature

Does the Tendency to Thrombosis Increase in Autoimmune Thyroid Dysfunction? Rotational Thromboelastometric Analysis

Endogenous fibrinolysis—Relevance to clinical thrombosis risk assessment

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