Admission Viscoelastic Hemostatic Assay Parameters Predict Poor Long-Term Intracerebral Hemorrhage Outcomes.

Autor: Sieh L; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Peasley E; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Mao E; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Mitchell A; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Heinonen G; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Ghoshal S; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Agarwal S; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Park S; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Connolly ES; Department of Neurological Surgery, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Claassen J; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA., Moore EE; Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, USA., Hansen K; Department of Biochemistry and Molecular Genetics, University of Colorado Denver, Aurora, CO, USA., Hod EA; Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Francis RO; Department of Pathology and Cell Biology, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA., Roh DJ; Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, 177 Fort Washington Ave, New York, NY, 10032, USA. dr2753@cumc.columbia.edu.
Jazyk: angličtina
Zdroj: Neurocritical care [Neurocrit Care] 2024 Jul 02. Date of Electronic Publication: 2024 Jul 02.
DOI: 10.1007/s12028-024-02051-w
Abstrakt: Background: Viscoelastic hemostatic assays (VHAs) provide more comprehensive assessments of coagulation compared with conventional coagulation assays. Although VHAs have enabled guided hemorrhage control therapies, improving clinical outcomes in life-threatening hemorrhage, the role of VHAs in intracerebral hemorrhage (ICH) is unclear. If VHAs can identify coagulation abnormalities relevant for ICH outcomes, this would support the need to investigate the role of VHAs in ICH treatment paradigms. Thus, we investigated whether VHA assessments of coagulation relate to long-term ICH outcomes.
Methods: Patients with spontaneous ICH enrolled into a single-center cohort study receiving admission Rotational Thromboelastometry (ROTEM) VHA testing between 2013 and 2020 were assessed. Patients with previous anticoagulant use or coagulopathy on conventional coagulation assays were excluded. Primary ROTEM exposure variables were coagulation kinetics and clot strength assessments. Poor long-term outcome was defined as modified Rankin Scale ≥ 4 at 6 months. Logistic regression analyses assessed associations of ROTEM parameters with clinical outcomes after adjusting for ICH severity and hemoglobin concentration.
Results: Of 44 patients analyzed, the mean age was 64 years, 57% were female, and the median ICH volume was 23 mL. Poor 6-month outcome was seen in 64% of patients. In our multivariable regression models, slower, prolonged coagulation kinetics (adjusted odds ratio for every second increase in clot formation time 1.04, 95% confidence interval 1.00-1.09, p = 0.04) and weaker clot strength (adjusted odds ratio for every millimeter increase of maximum clot firmness 0.84, 95% confidence interval 0.71-0.99, p = 0.03) were separately associated with poor long-term outcomes.
Conclusions: Slower, prolonged coagulation kinetics and weaker clot strength on admission VHA ROTEM testing, not attributable to anticoagulant use, were associated with poor long-term outcomes after ICH. Further work is needed to clarify the generalizability and the underlying mechanisms of these VHA findings to assess whether VHA-guided treatments should be incorporated into ICH care.
(© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.)
Databáze: MEDLINE
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