Wiśniewski Adam, Karczmarska-Wódzka Aleksandra, Sikora Joanna, Sobczak Przemysław, Lemanowicz Adam, Filipska Karolina, Ślusarz Robert
Department of Neurology, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Experimental Biotechnology Research and Teaching Team, Department of Transplantology and General Surgery, Faculty of Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland.
Diagnostics (Basel). 2021 Apr 15;11(4):712. doi: 10.3390/diagnostics11040712.
Thromboelastography (TEG) measures coagulation function in venous blood. Previous studies have reported that this device providing an integrated data on dynamics of clot formation may be useful for predicting clinical outcome in ischemic stroke. We investigated whether a hypercoagulability detected by thrombelastography may be associated with larger size of acute ischemic infarct.
We included 40 ischemic stroke subjects with large artery atherosclerosis or small-vessel disease to a cross-sectional pilot study. Thrombelastography parameters related to time of clot formation (R- reaction time, K-clot kinetics), clot growth and strengthening (angle-alpha and MA-maximum amplitude) and lysis (Ly30) were performed within first 24 h after the onset of stroke. A volume of ischemic infarct was assessed on the basis of diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging.
In the entire group, we reported that subjects with a large ischemic focus (>2 cm) had a higher diameter of a clot (measured as MA) than subjects with a small ischemic focus ( = 0.0168). In the large artery atherosclerosis subgroup, we showed a significant correlation between MA and size of acute infarct (R = 0.64, = 0.0138), between angle (alpha) and size of acute infarct (R = 0.55, = 0.0428) and stroke subjects with hypercoagulability (MA > 69 mm) had significantly higher probability of a larger size of acute ischemic focus compared to normalcoagulable subjects (5.45 cm vs. 1.35 cm; = 0.0298). In multivariate logistic regression hypercoagulability was a predictor of a large size of ischemic infarct (Odds ratio OR = 59.5; 95% confidence interval (CI) 1.08-3558.8; = 0.0488).
We emphasized that thrombelastography, based on the parameters related to clot strength, may have clinical utility to identify the risk of the extensive ischemic infarct.
血栓弹力图（TEG）用于测量静脉血中的凝血功能。既往研究报道，该设备可提供有关血凝块形成动态的综合数据，可能有助于预测缺血性卒中的临床结局。我们研究了通过血栓弹力图检测到的高凝状态是否可能与急性缺血性梗死灶更大有关。
我们纳入了40例患有大动脉粥样硬化或小血管疾病的缺血性卒中患者进行一项横断面初步研究。在卒中发作后的头24小时内进行与血凝块形成时间（R-反应时间、K-凝块动力学）、凝块生长和强化（角-α和MA-最大振幅）以及溶解（Ly30）相关的血栓弹力图参数检测。基于磁共振成像的扩散加权成像（DWI）序列评估缺血性梗死灶的体积。
在整个研究组中，我们发现有大面积缺血灶（>2 cm）的患者的血凝块直径（以MA测量）高于有小面积缺血灶的患者（P = 0.0168）。在大动脉粥样硬化亚组中，我们显示MA与急性梗死灶大小之间存在显著相关性（R = 0.64，P = 0.0138），角（α）与急性梗死灶大小之间存在显著相关性（R = 0.55，P = 0.0428），并且与正常凝血的患者相比，具有高凝状态（MA>69 mm）的卒中患者出现更大面积急性缺血灶的可能性显著更高（5.45 cm对1.35 cm；P = 0.0298）。在多因素逻辑回归分析中，高凝状态是大面积缺血性梗死的一个预测因素（比值比OR = 59.5；95%置信区间（CI）1.08 - 3558.8；P = 0.0488）。
我们强调，基于与凝块强度相关参数的血栓弹力图可能在识别广泛缺血性梗死风险方面具有临床应用价值。
