Thrombelastography Maximal Clot Strength Could Predict One-Year Functional Outcome in Patients with Ischemic Stroke

Abstract

Background: Elevated maximal clot strength, measured by thrombelastography (TEG) maximum amplitude (MA) has been associated with a higher risk for ischemic events in patients with coronary artery diseases. However, it has not been investigated in patients with cerebrovascular diseases. In the current study, we aimed to evaluate the predictive ability of TEG-MA in assessing the risk for ischemic event recurrence and the functional outcome after index ischemic stroke. Methods: This was a prospective observational study. Consecutive eligible patients with acute ischemic stroke were included and followed up for one year. Patients were stratified into tertile groups based on MA levels. TEG-hypercoagulability was defined as an MA of ≥69 mm. Ischemic events were defined as a composite of ischemic stroke, myocardial infarction, or vascular death (excluding hemorrhagic death). The functional outcome was evaluatewd by modified Rankin Scale (mRS). Unfavorable functional outcome was defined as mRS ≥2. Results: Two hundred and eleven patients were enrolled with 27 lost to follow-up at one year contact. At baseline, 38 (18.0%) patients were TEG-hypercoagulopathy after the treatment of antiplatelets. Patients with higher tertile of MA were more likely to be females, and had lower hemoglobin levels, higher platelet counts, higher fibrinogen levels, higher white blood cell counts, as well as higher ESR and hsCRP levels. Patients in the third tertile group were more likely to have intracranial artery stenosis and large-vessel subtype stroke than those in the other two groups. Higher tertile of MA was also related to stroke severity in acute phase (higher NIHSS scores on admission and longer in-hospital stay). At one year of follow-up, a higher percentage of unfavorable functional outcome and a non-significant trend of higher ischemic event rate were observed in higher MA tertile groups. Multivariate logistic analysis revealed that higher MA level (OR = 1.192, p = 0.022) was an independent predictor for unfavorable one-year functional outcome. Other independent predictors included old age (OR = 1.119, p = 0.001), diabetes mellitus (DM) (OR = 4.280, p = 0.014), previous ischemic stroke/TIA history (OR = 4.953, p = 0.008), and higher NIHSS scores on admission (OR = 1.437, p = 0.001). Conclusions: We found that higher TEG-MA levels could predict an unfavorable functional outcome after index ischemic stroke. Further, large-scale studies are required to investigate the relationship between MA levels and risk of recurrent ischemic events in ischemic stroke patients.

Hypercoagulation on Thromboelastography Predicts Early Neurological Deterioration in Patients with Acute Ischemic Stroke

“…By comparison, patients with END corresponded to a higher proportion of females (45.8 vs. 18.4%, p < 0.001), higher rates of DM history (38.9 vs. 20.1%, p = 0.015), higher baseline NIHSS score (5 [3][4][5][6][7][8][9] vs. 2 [1][2][3][4], p = 0.001), and higher serum high-sensitivity C-reactive protein (hsCRP) levels (5.60 [2.46-7.14] vs. 1.65 [0.70-4.68], p = 0.002). In the comparison of TEG parameters, patients in the END group had a significantly shorter reaction time R (4.0 ± 1.0 vs. 4.7 ± 1.2 min, p < 0.001) and kinetic time K (1.3 ± 0.4 vs. 1.5 ± 0.4 min, p = 0.003) than patients without END.…”

“…Currently, there is great interest in the clinical applications of thromboelastography (TEG), which can provide an integrated view of the viscoelasticity and coagulability properties of blood. Some studies have suggested that TEG is a useful tool for predicting stroke recurrence in patients with cardiovascular diseases [9,10]. However, few studies have assessed whether and to what degree TEG findings are associated with ischemic tissue evolution in patients with acute ischemic stroke.…”

Review of Thromboelastography in Neurocritical Care

“…Yao et al recently described the use of TEG in AIS patients. They obtained a TEG on a cohort of 211 patients with AIS and found that hypercoagulability on TEG (defined on this cohort as an MA of C69 mm) was found to be an independent predictor of an unfavorable outcome at 1 year [31].…”

Integrated laboratory coagulation tests in hypercoagulation diagnosis and thrombosis risk assessment. Part II. The sensitivity of integral tests to hypercoagulable states

“…Разнородность данных не позволи-ла провести метаанализ. Несколько более поздних работ подтверждают предсказательную силу параметра максимальной амплитуды (МА): МА либо G (жест-кость сгустка = 5,000 MA / 100 -MA) у пациентов по-сле операций является независимым фактором риска повторного ишемического инсульта (ОШ 1,192; p = 0,022) [49], а также других тромботических осложне-ний, в том числе инфаркта миокарда [50,51]. Подоб-ные данные имеются для аналога ТЭГ -ROTEM [47].…”

“…Подоб-ные данные имеются для аналога ТЭГ -ROTEM [47]. Параметр МА в основном определяется функцией тромбоцитов и концентрацией фибриногена [52], что объясняет отсутствие корреляции МА с АЧТВ и МНО [49].…”