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Thromb Haemost 2023; 123(12): 1180-1186
DOI: 10.1055/a-2084-5018
Stroke, Systemic or Venous Thromboembolism

Hypercoagulability on Thromboelastography Can Predict the Functional Outcomes in Patients with Acute Ischemic Stroke

Jae-Chan Ryu 
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Jae-Han Bae
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sang Hee Ha
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Bum Joon Kim
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sang-Beom Jeon
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Dong-Wha Kang
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Sun U. Kwon
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
,
Jong S. Kim
2   Department of Neurology, Gangneung Asan Hospital, University of Ulsan, College of Medicine, Gangneung, Republic of Korea
,
Jun Young Chang
1   Department of Neurology, Asan Medical Center, University of Ulsan, College of Medicine, Seoul, Republic of Korea
› Author Affiliations Funding This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant no. HR18C0016).
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Abstract

Background We investigated the association between the reaction time (R), a thromboelastography (TEG) parameter for hypercoagulability, and functional outcomes based on the occurrence of hemorrhagic transformation (HT) and early neurological deterioration (END).

Methods We enrolled ischemic stroke patients and performed TEG immediately after the patients' arrival. The baseline characteristics, occurrence of HT and END, stroke severity, and etiology were compared according to the R. END was defined as an increase of ≥1 point in motor or ≥2 points in the total National Institute of Health Stroke Scale within 3 days after admission. The outcome was the achievement of functional independence (modified Rankin scale [mRS]: 0–2) at 3 months after stroke. Logistic regression analyses were performed to verify the association between R and outcome.

Results HT and END were frequently observed in patients with an R of <5 minutes compared with the group with an R of ≥5 minutes (15 [8.1%] vs. 56 [21.0%], p < 0.001; 16 [8.6%] vs. 65 [24.3%], p = 0.001, respectively). In multivariable analysis, an R of <5 minutes was associated with decreased odds of achieving functional independence (0.58 [0.34–0.97], p = 0.038). This association was maintained when the outcome was changed to disability free (mRS 0–1) and when mRS was analyzed as an ordinal variable.

Conclusion Hypercoagulability on TEG (R <5 minutes) may be a negative predictor for functional outcome of stroke after 3 months, with more frequent HT, END, and different stroke etiologies. This study highlights the potential of TEG parameters as biomarkers for predicting functional outcomes in ischemic stroke patients.

Keywords

thromboelastography - reaction time - functional outcome - hypercoagulability - ischemic stroke

Supplementary Material



Publication History

Received: 19 July 2022

Accepted: 28 April 2023

Accepted Manuscript online:
02 May 2023

Article published online:
30 May 2023

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Comment to this article:

Hypercoagulability State in Predicting Severe Functional Outcome in Patients with Acute Ischemic Stroke: Cause, Consequence, or Both?Thromb Haemost 2023; 123(12): 1187-1189
DOI: 10.1055/s-0043-1771029