Ex vivo effect of hemostatic therapy in subarachnoid and intracerebral hemorrhage

Hvas, Christine Lodberg; Lauridsen, Signe Voigt; Pedersen, Emilie Sandgaard; Gyldenholm, Tua; Hvas, Anne‐Mette

doi:10.1016/j.thromres.2020.02.012

Cited by 6 publications

(17 citation statements)

References 31 publications

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“…55,67 Between studies, clot initiation, amplifica-tion, and strength were changed to different degrees. While the low tissue factor ROTEM assay revealed changes toward hypercoagulation in all phases of coagulation on admission, 53 the commercially available ROTEM assay revealed only increased clot strength 54 ; however, this was revealed in both ExTEM and FibTEM maximum clot firmness. Miao et al and El-Khawas et al, applying TEG, found primarily faster clot initiation on admission, while clot strength did not reach significant increase until 72 hours after ictus.…”

Section: Secondary Hemostasismentioning

confidence: 93%

“…Overall, mean platelet count on admission was within reference range or equivalent to the control group in all studies measuring this. 30,31,36,[49][50][51][52][53][54][55][56] In one study, the platelet count was higher in aSAH patients than in the control group, but a reference range was not provided. 57 When measured over days following aSAH, platelet count tended to decrease with a minimum between days 4 and 14.…”

Section: Primary Hemostasismentioning

confidence: 99%

“…37 Prothrombin time (PT), international normalized ratio (INR), and activated partial thromboplastin time (aPTT) were all consequently within reference ranges. 35,37,42,[49][50][51]53,65,66…”

Section: Primary Hemostasis and Outcomementioning

confidence: 99%

“…Studies employing dynamic assays are presented in ►Tables 2 (n ¼ 11), [49][50][51][52][58][59][60][61]63,68,69 3 (n ¼ 7), [53][54][55]57,66,67,70 and 4 (n ¼ 5), 56,62,64,65,71 according to their primary aim. ►Table 2 contains studies evaluating platelet function applying either platelet aggregation analyses or viscoelastic assays.…”

Section: Studies Employing Dynamic Assaysmentioning

confidence: 99%

“…Three of the studies partly shared the same cohort. 53,54,65 Three studies used ROTEM [53][54][55] and five studies used TEG. 56,57,66,67,70 Assays vary between studies, as both commercial ROTEM 54,55 and TEG assays 57,67,70 were applied, as well as TEG6 66 and a low tissue factor ROTEM assay.…”

Section: Secondary Hemostasismentioning

confidence: 99%

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Hemostasis and Fibrinolysis following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review on Additional Knowledge from Dynamic Assays and Potential Treatment Targets

Hvas

2021

Semin Thromb Hemost

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Mortality after aneurysmal subarachnoid hemorrhage (aSAH) is augmented by rebleeding and delayed cerebral ischemia (DCI). A range of assays evaluating the dynamic process of blood coagulation, from activation of clotting factors to fibrinolysis, has emerged and a comprehensive review of hemostasis and fibrinolysis following aSAH may reveal targets of treatment. We conducted a systematic review of existing literature assessing coagulation and fibrinolysis following aSAH, but prior to treatment. PubMed, Embase, and Web of Science were searched on November 18, 2020, without time boundaries. In total, 45 original studies were eventually incorporated into this systematic review, divided into studies presenting data only from conventional or quantitative assays (n = 22) and studies employing dynamic assays (n = 23). Data from conventional or quantitative assays indicated increased platelet activation, whereas dynamic assays detected platelet dysfunction possibly related to an increased risk of rebleeding. Secondary hemostasis was activated in conventional, quantitative, and dynamic assays and this was related to poor neurological outcome and mortality. Studies systematically investigating fibrinolysis were sparse. Measurements from conventional or quantitative assays, as well as dynamic fibrinolysis assays, revealed conflicting results with normal or increased lysis and changes were not associated with outcome. In conclusion, dynamic assays were able to detect reduced platelet function, not revealed by conventional or quantitative assays. Activation of secondary hemostasis was found in both dynamic and nondynamic assays, while changes in fibrinolysis were not convincingly demonstrable in either dynamic or conventional or quantitative assays. Hence, from a mechanistic point of view, desmopressin to prevent rebleeding and heparin to prevent DCI may hold potential as therapeutic options. As changes in fibrinolysis were not convincingly demonstrated and not related to outcome, the use of tranexamic acid prior to aneurysm closure is not supported by this review.

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Section: Secondary Hemostasismentioning

confidence: 93%

Section: Primary Hemostasismentioning

confidence: 99%

Section: Primary Hemostasis and Outcomementioning

confidence: 99%

Section: Studies Employing Dynamic Assaysmentioning

confidence: 99%

Section: Secondary Hemostasismentioning

confidence: 99%

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Hemostasis and Fibrinolysis following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review on Additional Knowledge from Dynamic Assays and Potential Treatment Targets

Hvas

2021

Semin Thromb Hemost

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A Systematic Review of Viscoelastic Testing in Patients with Subarachnoid Hemorrhage

et al. 2023

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Viscoelastic Testing in the Clinical Management of Subarachnoid Hemorrhage and Intracerebral Hemorrhage

Hvas

2022

Semin Thromb Hemost

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Subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH) are both debilitating and life-threatening incidents calling for immediate action and treatment. This review focuses on the applicability of viscoelastic testing (rotational thromboelastometry or thromboelastography [TEG]) in the management of SAH and ICH. A systematic literature search was performed in PubMed and EMBASE. Studies including patients with SAH or ICH, in which viscoelastic testing was performed, were identified. In total, 24 studies were included for analysis, and further subdivided into studies on SAH patients investigated prior to stenting or coiling (n = 12), ICH patients (n = 8) and studies testing patients undergoing stenting or coiling, or ischemic stroke patients undergoing thrombolysis or thrombectomy and developing ICH as a complication (n = 5). SAH patients had increased clot firmness, and this was associated with a higher degree of early brain injury and higher Hunt-Hess score. SAH patients with delayed cerebral ischemia had higher clot firmness than patients not developing delayed cerebral ischemia. ICH patients showed accelerated clot formation and increased clot firmness in comparison to healthy controls. Patients with hematoma expansion had longer clot initiation and lower platelet aggregation than patients with no hematoma expansion. During stent procedures for SAH, adjustment of antiplatelet therapy according to TEG platelet mapping did not change prevalence of major bleeding, thromboembolic events, or functional outcome. Viscoelastic testing prior to thrombolysis showed conflicting results in predicting ICH as complication. In conclusion, viscoelastic testing suggests hypercoagulation following SAH and ICH. Further investigation of the predictive value of increased clot firmness in SAH seems relevant. In ICH, the prediction of hematoma expansion and ICH as a complication to thrombolysis might be clinically relevant.

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Ex vivo effect of hemostatic therapy in subarachnoid and intracerebral hemorrhage

Cited by 6 publications

References 31 publications

Hemostasis and Fibrinolysis following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review on Additional Knowledge from Dynamic Assays and Potential Treatment Targets

Hemostasis and Fibrinolysis following Aneurysmal Subarachnoid Hemorrhage: A Systematic Review on Additional Knowledge from Dynamic Assays and Potential Treatment Targets

A Systematic Review of Viscoelastic Testing in Patients with Subarachnoid Hemorrhage

Viscoelastic Testing in the Clinical Management of Subarachnoid Hemorrhage and Intracerebral Hemorrhage

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