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

Qiuguang He,Chang Liu,You Zhou,Zongyi Xie,Yue Wu,Si Cheng,Zhongqiu Chen,Yuan Cheng,Rong Wen

doi:10.3389/fneur.2021.746024

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.

Highlights

Spontaneous intracerebral hemorrhage (ICH) accounts for 20% of all strokes and carries the highest stroke-related morbidity and mortality [1, 2]
Inclusion criteria were as follows: [1] baseline computed tomography (CT) scan was obtained within 6 h of symptom onset and [2] follow-up CT scan was acquired within 24 h of the baseline CT scan
The area under the curve (AUC) were 0.727 for arachidonic acid (AA) inhibition and 0.721 for adenosine diphosphate (ADP) inhibition

Summary

Introduction

Spontaneous intracerebral hemorrhage (ICH) accounts for 20% of all strokes and carries the highest stroke-related morbidity and mortality [1, 2]. Hematoma expansion (HE) usually occurs within the first few hours and is the main cause of worse functional outcome [3, 4]. Recent ICH trials with hemostatic drugs, such as recombinant activated coagulation factor VII (rFVIIa) and tranexamic acid, did not reveal beneficial effects [5, 6]. The role of platelet function on the occurrence of HE is insufficiently established, which may be due to the lack of effective detection methods [7]. 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)

Objectives

Methods

Results

Conclusion