PDF(Pubmed)
Abstract：
UNASSIGNED: Viscoelastic hemostatic assays (VHA) provide more comprehensive assessments of coagulation compared to conventional coagulation assays. While VHAs have enabled guided hemorrhage control therapies, improving clinical outcomes in life-threatening hemorrhage, the role of VHAs in intracerebral hemorrhage (ICH) is unclear. If VHAs can identify coagulation abnormalities relevant for ICH outcomes, this would support the need to investigate the role of VHAs in ICH treatment paradigms. Thus, we investigated whether VHA assessments of coagulation relate to long-term ICH outcomes.
UNASSIGNED: Spontaneous ICH patients enrolled into a single-center cohort study receiving admission Rotational Thromboelastometry (ROTEM) VHA testing between 2013 and 2020 were assessed. Patients with prior anticoagulant use or coagulopathy on conventional coagulation assays were excluded. Primary ROTEM exposure variables were coagulation kinetics and clot strength assessments. Poor long-term outcome was defined as modified Rankin Scale ≥ 4 at 6 months. Logistic regression analyses assessed associations of ROTEM parameters with clinical outcomes after adjusting for ICH severity and hemoglobin concentration.
UNASSIGNED: Of 44 patients analyzed, mean age was 64, 57% were female, and the median ICH volume was 23 mL. Poor 6-month outcome was seen in 64%. In our multivariable regression models, slower, prolonged coagulation kinetics (adjusted OR for every second increase in clot formation time: 1.04, 95% CI: 1.00-1.09, p = 0.04) and weaker clot strength (adjusted OR for every millimeter increase of maximum clot firmness: 0.84, 95% CI: 0.71-0.99, p = 0.03) were separately associated with poor long-term outcomes.
UNASSIGNED: Slower, prolonged coagulation kinetics and weaker clot strength on admission VHA ROTEM testing, not attributable to anticoagulant use, were associated with poor long-term outcomes after ICH. Further work is needed to clarify the generalizability and the underlying mechanisms of these VHA findings to assess whether VHA guided treatments should be incorporated into ICH care.
UNASSIGNED: Spontaneous ICH patients enrolled into a single-center cohort study receiving admission Rotational Thromboelastometry (ROTEM) VHA testing between 2013 and 2020 were assessed. Patients with prior anticoagulant use or coagulopathy on conventional coagulation assays were excluded. Primary ROTEM exposure variables were coagulation kinetics and clot strength assessments. Poor long-term outcome was defined as modified Rankin Scale ≥ 4 at 6 months. Logistic regression analyses assessed associations of ROTEM parameters with clinical outcomes after adjusting for ICH severity and hemoglobin concentration.
UNASSIGNED: Of 44 patients analyzed, mean age was 64, 57% were female, and the median ICH volume was 23 mL. Poor 6-month outcome was seen in 64%. In our multivariable regression models, slower, prolonged coagulation kinetics (adjusted OR for every second increase in clot formation time: 1.04, 95% CI: 1.00-1.09, p = 0.04) and weaker clot strength (adjusted OR for every millimeter increase of maximum clot firmness: 0.84, 95% CI: 0.71-0.99, p = 0.03) were separately associated with poor long-term outcomes.
UNASSIGNED: Slower, prolonged coagulation kinetics and weaker clot strength on admission VHA ROTEM testing, not attributable to anticoagulant use, were associated with poor long-term outcomes after ICH. Further work is needed to clarify the generalizability and the underlying mechanisms of these VHA findings to assess whether VHA guided treatments should be incorporated into ICH care.
摘要：
背景技术与常规凝血测定相比,粘弹性止血测定(VHA)提供更全面的凝血评估。虽然VHA已经实现了指导出血控制治疗，改善危及生命的出血的临床结果，VHAs在脑出血(ICH)中的作用尚不清楚.如果VHAs可以识别与ICH结果相关的凝血异常，这将支持需要研究VHAs在ICH治疗模式中的作用.因此，我们调查了VHA对凝血功能的评估是否与长期ICH结局相关.方法对2013年至2020年接受旋转血栓弹性测量（ROTEM）VHA测试的单中心队列研究中的自发性ICH患者进行评估。排除先前使用抗凝剂或常规凝血检测有凝血障碍的患者。主要的ROTEM暴露变量是凝血动力学和凝块强度评估。不良长期结局定义为6个月时改良Rankin量表≥4。Logistic回归分析在校正ICH严重程度和血红蛋白浓度后评估ROTEM参数与临床结果的关联。结果对44例患者进行分析,平均年龄64岁，57%为女性，中位ICH体积为23mL。在64％的患者中观察到6个月的不良结果。在我们的多元回归模型中，更慢,凝血动力学延长(凝块形成时间每增加1秒调整OR:1.04,95%CI:1.00~1.09,p=0.04)和凝块强度较弱(最大凝块硬度每增加1毫米调整OR:0.84,95%CI:0.71~0.99,p=0.03)分别与不良长期结局相关.结论较慢,入院时凝血动力学延长和凝块强度较弱的VHAROTEM测试，不能归因于抗凝剂的使用，与ICH后不良的长期结局相关。需要进一步的工作来阐明这些VHA研究结果的普遍性和潜在机制，以评估VHA指导治疗是否应纳入ICH护理。
