Thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in acute ischemic stroke: an association study

Abstract

Objective To explore the association, consistency and complications prognostic value of thromboelastography and conventional coagulation tests in detecting coagulation function of antiplatelet after endovascular treatments in patients with acute ischemic stroke. Methods A retrospective cohort survey of 240 patients, admitted to our hospital from September 2012 to December 2017, was performed. All acute ischemic stroke patients accepted coagulation function monitoring 5 d after aspirin and clopidogrel and endovascular treatments by thromboelastography (R time, K time, α angle, maximum amplitude [MA]) and routine coagulation tests (prothrombin time [PT], activated partial thromboplastin time [APTT], fibrinogen [FIB], international normalized ratio [INR], blood platelet count). The association, consistency, and sensitivity, specificity, positive predictive value, negative predictive value of complications prognostic value of thromboelastography and conventional coagulation tests were analyzed. Results (1) R time and APTT, K time and APTT, α angle and FIB, and α angle and PLT were positively correlated; K time and FIB, R time and PLT, and α angle and APTT were negatively correlated. (2) R time and APTT (κ=0.266, P=0.000), K time and APTT (κ=0.134, P=0.024), and α angle and FIB (κ=0.162, P=0.007) had agreement in identifying hypercoagulability; R time and APTT (κ= 0.211, P=0.001), K time and APTT (κ=0.198, P=0.002), and blood platelet count and K (κ=0.388, P= 0.000), and α angle and PLT (κ=0.099, P=0.041) had agreement in identifying hypocoagulability. (3) The sensitivity of thromboelastography and routine coagulation tests in identifying early neurological deterioration was 17.65% and 58.82%, and the sensitivity in identifying symptomatic hemorrhages by thromboelastography and routine coagulation tests was 73.68% and 47.39%. Conclusions Some parameters has correlations in peroperative period, and has agreement in identifying hypercoagulability and hypocoagulability. Accordingly, routine coagulation tests might be superior in evaluating early neurological deterioration, and thromboelastography might be superior in evaluating symptomatic hemorrhages in patients with acute ischemic stroke Key words: Thromboelastography; Routine coagulation test; Coagulation function monitoring; Acute ischemic stroke; Endovascular treatment; Antiplatelet treatment