Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke.
Publication/Presentation Date
4-1-2016
Abstract
Thrombelastography (TEG) measures coagulation in venous blood. We hypothesized that TEG, by reflecting clot subtype and ex vivo fibrinolysis, might predict fibrinolytic response to tPA as reflected by rapid clinical improvement or hemorrhagic transformation of the infarct. 171 acute ischemic stroke patients treated with tPA were prospectively enrolled. Venous blood for TEG was drawn before and 10 min after tPA bolus. We measured rapid clinical improvement (RCI = 8 point improvement on NIHSS or total NIHSS of 0, 1 at 36 h), Hemorrhagic transformation (HT = any blood on imaging within 36 h), and hyperdense middle cerebral artery sign (HDMCA = biomarker for erythrocyte-rich clot). Multivariable regression models compared TEG parameters after adjusting for potential confounders. No differences in pre- or post-tPA TEG were found between patients with or without RCI. Also, there was no correlation between TEG and HDMCA. Clotting was slightly prolonged in patients with HT (p = 0.046). We failed to find a robust association between TEG and clinical response to tPA. It is likely that arterial clot lysis is determined by factors unrelated to coagulation status as measured by TEG in the venous circulation. It is unlikely that TEG will be useful to predict clinical response to tPA, but may help predict bleeding.
Volume
41
Issue
3
First Page
505
Last Page
510
ISSN
1573-742X
Published In/Presented At
McDonald, M. M., Wetzel, J., Fraser, S., Elliott, A., Bowry, R., Kawano-Castillo, J. F., Cai, C., Sangha, N., Messier, J., Hassler, A., Archeval-Lao, J., Parker, S. A., Rahbar, M. H., Pivalizza, E. G., Chang, T. R., & Grotta, J. C. (2016). Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke. Journal of thrombosis and thrombolysis, 41(3), 505–510. https://doi.org/10.1007/s11239-015-1280-9
Disciplines
Medicine and Health Sciences
PubMedID
26407682
Department(s)
Department of Medicine
Document Type
Article