A Systematic Review of Viscoelastic Testing in Patients with Subarachnoid Hemorrhage

Tjerkstra, Maud A.; Wolfs, Anne E; Verbaan, Dagmar; Horn, Janneke; Müller, Marcella C.A.; Juffermans, Nicole P.

doi:10.1016/j.wneu.2023.03.108

Cited by 5 publications

(4 citation statements)

References 40 publications

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“…The hypercoagulable profiles were determined by parameters of clot kinetics and clot strength on days 3-5 and 9-11, indicating increased platelet activity and fibrinogen contribution to blood clot formation, which is in line with previous studies using rotational thromboelastography (TEG, a comparable viscoelastic test). 14,28–31 FIBTEM markers yielded the highest area-under-the-curves, with comparable discriminative ability to the most commonly used prognosticator, the WFNS grade. 32,33 The contribution of fibrinogen to poor clinical outcome in aSAH may be in line with recent insights into the role of fibrinogen in amplifying immune and degenerative processes in the brain in various neurological diseases and following neurotrauma.…”

Section: Discussionmentioning

confidence: 87%

“…13 Studies have shown a hypercoagulable ROTEM-profile in aSAH patients compared to controls, already present early after ictus and worsening over time. 14–19 To date, two studies have evaluated ROTEM in DCI patients and showed hypercoagulability within 72 hours following SAH. 14,18,20 These studies evaluated group differences of a few ROTEM-parameters only, and were limited by small sample sizes, hampering determination of cut-off values.…”

Section: Introductionmentioning

confidence: 99%

“…14–19 To date, two studies have evaluated ROTEM in DCI patients and showed hypercoagulability within 72 hours following SAH. 14,18,20 These studies evaluated group differences of a few ROTEM-parameters only, and were limited by small sample sizes, hampering determination of cut-off values.…”

Section: Introductionmentioning

confidence: 99%

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The discriminative ability of ROTEM for Delayed Cerebral Ischemia and Poor Clinical Outcome following Aneurysmal Subarachnoid Haemorrhage

Tjerkstra,

Labib,

Coert

et al. 2023

Preprint

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IntroductionAneurysmal subarachnoid haemorrhage (aSAH) and delayed cerebral ischemia (DCI) have been associated with hypercoagulability as detected by viscoelastic testing. In this study, we evaluate temporal alterations in rotational thromboelastography (ROTEM-) coagulation profiles and the discriminative ability of ROTEM-parameters for DCI and poor clinical outcome following aSAH.Materials and MethodsROTEM-parameters were measured on days 0, 3-5 and 9-11 after aSAH and compared between patients with and without DCI, radiological DCI and 6-months’ poor clinical outcome (modified Rankin Scale 4-6). ROC-curve analyses were used to calculate areas-under-the-curve (AUC) and to determine optimal cut-off values with a sensitivity of >90% and highest possible specificity for DCI and radiological DCI. For poor outcome, a specificity >90% with highest possible sensitivity was used.ResultsOf 160 aSAH patients, 31 (19%) had DCI, 16 (10%) radiological DCI and 68 (44%) had poor outcome at six months. DCI, radiological DCI and poor clinical outcome were associated with hypercoagulability. The ROTEM-parameter with the best discriminative ability for radiological DCI was INTEM CT (AUC: 0.75), with optimal cut-off value <153 seconds (sensitivity 94%, specificity 59%). For poor outcome, this was FIBTEM A10, (AUC: 0.85), with optimal cut-off value >27 mm (specificity 94%, sensitivity 49%).ConclusionsHypercoagulability, as detected by ROTEM-parameters, is an excellent marker of poor clinical outcome after aSAH and might be useful for stratifying patients for inclusion in future trials on therapeutic interventions. Conversely, the absence of hypercoagulability on ROTEM may be used to identify patients at low risk of DCI for early hospital discharge.

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Section: Discussionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

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The discriminative ability of ROTEM for Delayed Cerebral Ischemia and Poor Clinical Outcome following Aneurysmal Subarachnoid Haemorrhage

Tjerkstra,

Labib,

Coert

et al. 2023

Preprint

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“…Prophylactic low-molecular weight heparin was started on the third post-intervention day. In the acute phase, platelet function testing was not done due to the unreliability of the platelet function tests in the setting of SAH [ 18 ]. Prasugrel was generally continued for 6 months and aspirin for life.…”

Section: Methodsmentioning

confidence: 99%

Flow diversion of ruptured intracranial aneurysms: a single-center study with a standardized antithrombotic treatment protocol

Rantamo,

Gallé,

Numminen

et al. 2024

Acta Neurochir

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Background The use of antithrombotic medication following acute flow diversion for a ruptured intracranial aneurysm (IA) is challenging with no current guidelines. We investigated the incidence of treatment-related complications and patient outcomes after flow diversion for a ruptured IA before and after the implementation of a standardized antithrombotic medication protocol. Methods We conducted a single-center retrospective study including consecutive patients treated for acutely ruptured IAs with flow diversion during 2015–2023. We divided the patients into two groups: those treated before the implementation of the protocol (pre-protocol) and those treated after the implementation of the protocol (post-protocol). The primary outcomes were hemorrhagic and ischemic complications. A secondary outcome was clinical outcome using the modified Ranking Scale (mRS). Results Totally 39 patients with 40 ruptured IAs were treated with flow diversion (69% pre-protocol, 31% post-protocol). The patient mean age was 55 years, 62% were female, 63% of aneurysms were in the posterior circulation, 92% of aneurysms were non-saccular, and 44% were in poor grade on admission. Treatment differences included the use of glycoprotein IIb/IIIa inhibitors (pre-group 48% vs. post-group 100%), and the use of early dual antiplatelets (pre-group 44% vs. 92% post-group). The incidence of ischemic complications was 37% and 42% and the incidence of hemorrhagic complications was 30% and 33% in the pre- and post-groups, respectively, with no between-group differences. There were three (11%) aneurysm re-ruptures in the pre-group and none in the post-group. There were no differences in mortality or mRS 0–2 between the groups at 6 months. Conclusion We found no major differences in the incidence of ischemic or hemorrhagic complications after the implementation of a standardized antithrombotic protocol for acute flow diversion for ruptured IAs. There is an urgent need for more evidence-based guidelines to optimize antithrombotic treatment after flow diversion in the setting of subarachnoid hemorrhage.

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

Sieh,

Peasley,

Mao

et al. 2024

Neurocrit Care

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A Systematic Review of Viscoelastic Testing in Patients with Subarachnoid Hemorrhage

Cited by 5 publications

References 40 publications

The discriminative ability of ROTEM for Delayed Cerebral Ischemia and Poor Clinical Outcome following Aneurysmal Subarachnoid Haemorrhage

The discriminative ability of ROTEM for Delayed Cerebral Ischemia and Poor Clinical Outcome following Aneurysmal Subarachnoid Haemorrhage

Flow diversion of ruptured intracranial aneurysms: a single-center study with a standardized antithrombotic treatment protocol

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

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