The Relationship Between Thromboelastography and Clinical Outcome in Acute Stroke Patients Receiving Thrombolytic Therapy

Year 2020, Volume: 42 Issue: 5, 577 - 583, 15.09.2020

Engin Özakın , Atilla Özcan Özdemir , Deniz Gören Şahin , Olga Meltem Akay Yasemin Dinç Arif Alper Cevik Nurdan Acar Filiz Baloğlu Kaya Muzaffer Bilgin

https://doi.org/10.20515/otd.605747

Abstract

Thromboelastography (TEG) is a hemostatic test that measures the shear
elasticity and the dynamics of clot formation and the strength and stability of
formed clot. There are limited data about TEG in acute ischemic stroke who
receives thrombolytic therapies. This study aimed to investigate the impact of
coagulation parameters obtained by rotational thrombelastography (ROTEM) method
on clinical outcome and intracerebral hemoorage in acute stroke patients
receiving thrombolytic treatment. The study included 29 patients with acute
stroke who received rtPA treatment between June 2013 and March 2014. Blood
samples were taken from the patients before starting thrombolytic therapy. By
ROTEM®; INTEM and EXTEM analysis, the parameters of CT (clotting time=sec), CFT
(clot formation time=sec) and MCF (maximum clot firmness=mm) were tested. The
demographic information of patients, NIHSS scores at the time and 24 hours
after the admission and brain tomography results were recorded. In addition,
the data obtained by ROTEM method were compared with the normal group.Compared
to healthy group, ischemic stroke patients had lower intemCT (p<0.05),
extemCT (p=0.01) and extemCFT (p<0.05) and higher extemMCF (p<0.05).  These results were consistent with
hypercoagulability. TEG parameters were not correlated with symptomatic
hemorrhage, mortality and poor outcome in patients who receive trombolytic treatment.Thrombelastography
shows that patients with ischemic stroke are in hypercoagulable state. Further
studies are needed to examine this observation and its relationship with
clinical outcome

Keywords

thromboelastography, stroke, mortality, hemorrhage

Trombolitik Tedavi Alan Akut Inmeli Hastalarda Tromboleastografi ile Klinik Sonlanım Arasındaki Ilişkinin Araştırılması

Abstract

Tromboelastografi (TEG), pıhtı
oluşumunun elastikiyetini ve dinamiklerini ve oluşan pıhtıların gücünü ve
stabilitesini ölçen hemostatik bir testtir. Trombolitik tedavi alan akut
iskemik inmede TEG hakkında sınırlı veri vardır. Bu çalışmada, trombolitik
tedavi alan akut inmeli hastalarda rotasyonel trombelastografi (ROTEM) yöntemi
ile elde edilen pıhtılaşma parametrelerinin klinik sonuç ve intraserebral
kanama üzerine etkisi araştırıldı. Çalışma, Haziran 2013-Mart 2014 tarihleri
arasında rtPA tedavisi alan akut inmeli 29 hasta içermiştir. Hastalardan
trombolitik tedaviye başlamadan önce kan örnekleri alındı. ROTEM® ile; INTEM ve
EXTEM analizi, CT (pıhtılaşma süresi = sn), CFT (pıhtı oluşum süresi = sn) ve
MCF (maksimum pıhtı sertliği = mm) parametreleri test edildi. Hastaların
demografik bilgileri, başvuru sırasındaki ve 24 saat sonra NIHSS skorları, 3.ay
mRs ve beyin tomografi sonuçları kaydedildi. Ayrıca ROTEM yöntemiyle elde
edilen veriler kontrol grup ile karşılaştırıldı.Sağlıklı gruba göre iskemik
inme hastalarında düşük intemCT (p <0.05), extemCT (p = 0.01) ve extemCFT (p
<0.05) ve daha yüksek extemMCF (p <0.05) vardı. Bu sonuçlar hiper
pıhtılaşabilirlik ile tutarlıydı. TEG parametreleri, trombolitik tedavi alan
hastalarda semptomatik kanama, mortalite ve 3 ay sonraki kötü klinik ile korele
değildi. Trombelastografi, iskemik inmeli hastaların hiper pıhtılaşma durumunda
olduğunu gösterir. Bu gözlemi ve klinik sonlanım ile ilişkisinin incelenmesi
için daha ileri çalışmalar gereklidir.

Keywords

Tromboelastografi, inme, mortalite, intraserebral kanama

References

• 1. Shaydakov, M.E. and J. Blebea, Thromboelastography (TEG), in StatPearls. 2019: Treasure Island (FL).
• 2. Tanaka, K.A., et al., Rotational thromboelastometry (ROTEM)-based coagulation management in cardiac surgery and major trauma. J Cardiothorac Vasc Anesth, 2012. 26(6): p. 1083-93.
• 3. Lloyd-Jones, D., et al., Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation, 2009. 119(3): p. 480-6.
• 4. Hacke, W., et al., Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med, 2008. 359(13): p. 1317-29.
• 5. Akay, O.M., et al., Laboratory investigation of hypercoagulability in cancer patients using rotation thrombelastography. Med Oncol, 2009. 26(3): p. 358-64.
• 6. Zivin, J.A., et al., Tissue plasminogen activator reduces neurological damage after cerebral embolism. Science, 1985. 230(4731): p. 1289-92.
• 7. National Institute of Neurological, D. and P.A.S.S.G. Stroke rt, Tissue plasminogen activator for acute ischemic stroke. N Engl J Med, 1995. 333(24): p. 1581-7.
• 8. Jauch, E.C., et al., Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2013. 44(3): p. 870-947.
• 9. Hacke, W., et al., Randomised double-blind placebo-controlled trial of thrombolytic therapy with intravenous alteplase in acute ischaemic stroke (ECASS II). Second European-Australasian Acute Stroke Study Investigators. Lancet, 1998. 352(9136): p. 1245-51.
• 10. Carroll, R.C., et al., Early evaluation of acute traumatic coagulopathy by thrombelastography. Transl Res, 2009. 154(1): p. 34-9.
• 11. Carroll, R.C., et al., A comparison of VerifyNowR with PlateletMappingR--detected aspirin resistance and correlation with urinary thromboxane. Anesth Analg, 2013. 116(2): p. 282-6.
• 12. Carroll, R.C., et al., Thrombelastography monitoring of resistance to enoxaparin anticoagulation in thrombophilic pregnancy patients. Thromb Res, 2007. 120(3): p. 367-70.
• 13. Andrea Elliott., et al Thromboelastography in Patients with Acute Ischemic Stroke. Int J Stroke. 2015 Feb; 10(2): 194–201.