Thromboelastography and routine coagulation test in short-term prognosis of acute cerebral infarction

Abstract

Objective To investigate the differences of thromboelastography (TEG) and routine coagulation test in evaluating the coagulation function of patients with acute cerebral infarction before antithrombotic therapy, and to evaluate the short-term prognosis of these two methods and their application values in guiding clinical intervention treatment. Methods The clinical data of 99 patients with acute cerebral infarction, admitted to our hospital from October 2016 to March 2018, were retrospectively analyzed. At admission, patients were assessed by TEG and routine coagulation test. All patients were assessed by National Institutes of Health Stroke Scale (NIHSS) at admission and 7 d after antithrombotic therapy and modified Rankin scale (mRS) at discharge. According to NIHSS scores, the patients were divided into neurological function poor prognosis group (NIHSS scores being decreased by less than 18% or being increased, n=49) and neurological function good prognosis group (NIHSS scores being decreased more than 18%, n=50). According to mRS scores, the patients were divided into living ability good prognosis group (mRS scores being less than/equal to 2, n=68) and living ability poor prognosis group (mRS scores being more than 3, n=27). When grouping patients with the above two scoring scales, the differences of coagulation functions between TEG and routine coagulation test were compared. The risk factors and protective factors affecting the neurological function and living ability of patients were analyzed using binary Logistic regression analysis, and receiver-operator characteristic (ROC) curve of the subjects was plotted. Results (1) In TEG indexes, response time of coagulation (R), α angle, maximum amplitude (MA), and composite index (CI) were significantly different between the neurological function poor prognosis group and neurological function good prognosis group (P 0.05), and all parameters of TEG had no statistical significance in Logistic regression analysis of prognosis of neurological function and prognosis of life ability (P>0.05). (3)ROC curve analysis showed that TT=17.3 s was the best diagnostic threshold for good prognosis of neurological function and poor prognosis of neurological function (area under curve [ACU]=0.738, sensitivity=94.7%, specificity=52.4%) and AT III=72.1% was the best diagnostic threshold for good prognosis of living ability and poor prognosis of living ability (ACU=0.740, sensitivity=95.8%, specificity= 61.5%); in ROC curve analysis of prognoses of neurological function and living ability, ACU of TEG indexes were all smaller than those of TT and AT III. Conclusion TEG is more sensitive and comprehensive than routine coagulation test in evaluating early changes of coagulation function and predicting short-term prognosis after antithrombotic therapy in patients with acute cerebral infarction, while routine coagulation test has higher application value in guiding clinical intervention treatment. Key words: Cerebral infarction; Antithrombotic therapy; Thromboelastography; Routine coagulation test; Neurological function; Living ability