Association of Thromboelastography With Hematoma Expansion and Disability in Spontaneous Intracerebral Hemorrhage: A Multicenter Study.

BACKGROUND AND

OBJECTIVES

Hematoma expansion (HE), an increase in bleeding into the brain, is a modifiable cause of disability and death after intracerebral hemorrhage (ICH). Some specialized hemostatic biomarkers are associated with HE. Widely available hemostatic biomarkers could improve our understanding of HE and lead to targeted treatments.

METHODS

We conducted a multicenter, prospective, cohort study of patients with spontaneous ICH between 2019 and 2023 at 6 medical centers across the United States. Patients with an initial CT scan within 12 hours of symptom onset were enrolled. All patients had initial and follow-up CT scans for HE calculation and a blood draw that occurred before follow-up imaging. Patients who received desmopressin were excluded from analysis. Correlation between continuous numerical variables (i.e., HE and hemostatic biomarkers) was calculated with Spearman correlation. Correlations between the 3-month modified Rankin Scale (mRS) and biomarkers were calculated using Kendall correlation.

RESULTS

We enrolled 82 patients with spontaneous ICH (34.1% women) with a mean age of 61 ± 13.3 years. Symptom onset occurred within a median time of 1.8 (1.15-4.48) hours before first CT scan imaging and 5.8 (4.45-7.57) hours before blood draw. Seventeen (21%) used aspirin, 4 (5%) used clopidogrel, and none used anticoagulants before ICH. The Thromboelastography (TEG) Coagulation Index, a composite calculation from individual parameters, was correlated with subsequent HE (r = -0.26, p = 0.01, 90% Conf. Int. [-1.0 to -0.11]). TEG K, a measure of fibrinogen-dependent clot strength, also correlated with HE (rho = 0.19, p = 0.048, 90% Conf. Int. [0.01-37.0]). TEG Maximum Amplitude (tau = -0.32, 90% Conf. Int [-0.57 to 0.0], p = 0.02), a measure of clot strength dependent on platelets, and HE (tau = 0.35, 90% Conf Int [0.1-0.6], p = 0.01) were associated with the 3-month mRS.

DISCUSSION: Hemostatic biomarkers from TEG, particularly those related to clot strength and fibrin generation, were associated with subsequent HE and the mRS at 3 months. These results suggest that hemostatic biomarkers have potential to predict HE and functional outcomes in a broad swath of patients with spontaneous ICH.