Department of Neurology, County Emergency Hospital, Cluj-Napoca, Romania.
University of Medicine and Pharmacy "Iuliu Hațieganu" Cluj-Napoca, Romania.
Semin Thromb Hemost. 2022 Oct;48(7):842-849. doi: 10.1055/s-0042-1753529. Epub 2022 Sep 2.
Acute ischemic stroke (AIS) due to cerebral artery occlusion is often treated by thrombolytics or antithrombotic drugs. Thromboelastography (TEG) is a noninvasive test that provides a dynamic overview of the coagulation process. TEG may help guide thrombolytic and antithrombotic therapy in AIS. This article aims to highlight the potential use of TEG in AIS patients by reviewing available studies. We conducted a literature review, including PubMed and Cochrane library databases. The following keywords were used to find relevant studies: thromboelastography, TEG, acute ischemic stroke, stroke, coagulopathy, antiplatelet, and anticoagulant treatment. We identified 142 papers and after abstract review, we included 24 studies in this report. TEG identified a hypercoagulable state in AIS patients represented by short R, K, and greater α: angle in all papers included. Modification of TEG parameters induced by intravenous thrombolysis was inconsistent but prolonged lysis (increased LY30) and weaker clots (lower maximum amplitude) were most frequent. TEG detected hypo-coagulopathy induced by dual antiplatelet therapy as well as antiplatelet drug resistance, with ticagrelor and aspirin having greater inhibition of platelet activity. A prolonged R-value seems to be the most reliable TEG parameter in detecting the anticoagulant effect of factor Xa inhibitor treatment. TEG might represent a useful point-of-care test for emergency decision-making in AIS patients and a tool for individualized treatment options. This hypothesis needs validation in a large cohort of prospectively studied AIS patients.
急性缺血性脑卒中（AIS）常因脑动脉闭塞而采用溶栓或抗血栓药物治疗。血栓弹力图（TEG）是一种非侵入性的检测方法，可提供凝血过程的动态概述。TEG 可能有助于指导 AIS 的溶栓和抗血栓治疗。本文旨在通过回顾现有研究，强调 TEG 在 AIS 患者中的潜在应用。我们进行了文献综述，包括 PubMed 和 Cochrane 图书馆数据库。使用以下关键词查找相关研究：血栓弹力图、TEG、急性缺血性脑卒中、脑卒中、凝血障碍、抗血小板和抗凝治疗。我们确定了 142 篇论文，经过摘要审查，我们在本报告中纳入了 24 项研究。所有纳入的研究均表明 TEG 识别出 AIS 患者的高凝状态，表现为 R、K 和 α：角缩短。静脉溶栓引起的 TEG 参数改变不一致，但最常见的是延长溶解（LY30 增加）和更弱的血栓（最大振幅降低）。TEG 检测到双联抗血小板治疗引起的低凝状态以及抗血小板药物抵抗，替格瑞洛和阿司匹林对血小板活性的抑制作用更强。延长 R 值似乎是检测因子 Xa 抑制剂治疗抗凝效果最可靠的 TEG 参数。TEG 可能代表一种有用的即时检测方法，用于 AIS 患者的紧急决策，并为个体化治疗方案提供工具。这一假设需要在一大组前瞻性研究的 AIS 患者中得到验证。
