Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Tampere University Hospital, Department of Intensive Care, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
J Neurol Sci. 2024 Mar 15;458:122943. doi: 10.1016/j.jns.2024.122943. Epub 2024 Feb 23.
Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome.
We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2-3, 4-5, 7-8, and 11-12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome.
DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1-4) on PBDs 4-5 and 7-8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4-5 (p < 0.05), PBD 7-8 (p < 0.05), and PBD 11-12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI.
Patients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI.
gov, NCT03985176.
蛛网膜下腔出血（aSAH）患者表现出增强的血液凝固，这被认为是导致迟发性脑缺血（DCI）和更差预后的原因。因此，我们试图确定这种可通过旋转血栓弹性测定法（ROTEM）检测到的增强的血液凝固是否与 DCI 和神经功能预后相关。
我们对 60 例连续的成年 aSAH 患者进行了前瞻性观察性研究。ROTEM 的 EXTEM 和 FIBTEM 检测以及 D-二聚体在入院时和出血后第 2-3、4-5、7-8 和 11-12 天进行分析。ROTEM 的凝血形成时间（CFT）代表血凝块的稳定，最大凝块硬度（MCF）代表最大凝块强度。三个月时的格拉斯哥预后扩展量表（GOSe）确定了神经功能预后。
DCI 的发生率为 41.7%。EXTEM-CFT 在第 4-5 和 7-8 天神经功能预后不良（GOSe 1-4）的患者中明显缩短，p<0.05。FIBTEM-MCF 在第 4-5 天（p<0.05）、第 7-8 天（p<0.05）和第 11-12 天（p<0.05）神经功能预后不良的患者中明显升高。在所有患者中，EXTEM-CFT 在研究期间降低，FIBTEM-MCF 升高。在所有研究时间点，神经功能预后不良的患者的 D-二聚体均较高，p<0.05。在评估有或无 DCI 的患者时，ROTEM 参数或 D-二聚体没有差异。
aSAH 后患者处于增强的血液凝固状态，神经功能预后不良的患者比预后良好的患者更具凝血能力。然而，增强的血液凝固与 DCI 无关。
gov，NCT03985176。
