Hypercoagulability on Thromboelastography Can Predict the Functional Outcomes in Patients with Acute Ischemic Stroke

Abstract

Background: Thromboelastography (TEG) is a useful test that evaluates the coagulation and fibrinolysis pathways. We investigated the association between the Reaction time (R), a TEG parameter for hypercoagulability, and functional outcome based on the occurrence of hemorrhagic transformation (HT) and early neurological deterioration (END). Methods: We enrolled ischemic stroke patients and performed TEG immediately after the patients’ arrival. The baseline characteristics, occurrence of HT and END, stroke severity, and etiology were compared according to the R. END was defined as an increase of ≥1-point in motor or ≥2-points in the total National Institute of Health Stroke Scale within 3 days after admission. The outcome was the achievement of a functional independence [modified Rankin Scale (mRS) 0–2] at 3-month after stroke. Logistic regression analyses were performed to verify the association between R and outcome. Results: HT and END were frequently observed in patients with a R of <5 min compared with the group with a R of ≥5 min (15 [8.1%] vs. 56 [21.0%], P<0.001; 16 [8.6%] vs. 65 [24.3%], P=0.001, respectively). In multivariable analysis, a R of <5 min was associated with decreased odds of achieving functional independence (0.58 [0.34–0.97], P=0.038). This association was maintained when the outcome was changed to disability-free (mRS 0–1) and when mRS was analyzed as an ordinal variable. Conclusion: A R of <5 min was a negative predictor of functional independence. Frequent HT, END, and different stroke etiologies according to the R may be the cause of poor outcome after ischemic stroke.

Alterations of Hemostatic Molecular Markers During Acute Large Vessel Occlusion Stroke

“… 12 , 13 , 14 , 15 , 16 , 31 Hypercoagulability, as indicated by thromboelastography (reaction time <5 minutes), has been observed in patients with AIS and negatively correlated with functional independence. 6 , 32 Our findings further suggested a more hyperactive coagulation‐fibrinolysis system in the local ischemic environment surrounding the thrombosis site compared with the systemic circulation, which was evidenced by significant increases in ischemic TAT, PIC, and D‐dimer concentrations. Moreover, we found that increased ischemic, but not systemic, TAT and PIC were independently associated with unfavorable 90‐day functional outcome.…”

“… 3 , 4 , 5 However, there is currently a lack of detailed coagulation‐fibrinolysis profiles during the hyperacute phase, and reliable laboratory tests are not yet available. 6 Hemostatic molecular markers including TAT (thrombin‐antithrombin complex), PIC (plasmin‐α2 plasmin inhibitor complex), t‐PAIC (tissue plasminogen activator‐plasminogen activator inhibitor complex), and sTM (soluble thrombomodulin) are increasingly investigated as potential indicators for an integrated perspective of early activation of the coagulation‐fibrinolysis system. These markers are particularly relevant to endothelial lesions associated with arterial and venous thrombosis.…”

Thrombosis and Haemostasis 2023 Editors' Choice Papers

“…The study from Ryu et al 52 suggested that thromboelastography could predict functional outcomes in acute ischemic stroke. They found a link between a hypercoagulable state (as identified by thromboelastography) and poorer functional independence, symptomatic/asymptomatic hemorrhagic transformation, and early neurological decline.…”