Thromboelastography Parameter Predicts Outcome After Subarachnoid Hemorrhage: An Exploratory Analysis.

Area of Science:

• Neurology
• Hematology
• Critical Care Medicine

Background:

• Subarachnoid hemorrhage (SAH) frequently leads to a hypercoagulable state, potentially driven by platelet dysfunction.
• Thromboelastography (TEG) offers a comprehensive assessment of blood coagulation.
• The maximum amplitude (MA) parameter of TEG reflects platelet strength and function.

Purpose of the Study:

• To investigate the association between TEG's maximum amplitude (MA) and patient outcomes following SAH.
• To determine if MA can serve as a predictor of hypercoagulability and functional outcomes post-SAH.

Main Methods:

• TEG analyses were conducted on 110 patients with moderate-to-severe SAH and compared to 6 healthy controls.
• Key TEG indices, including MA, G value, and alpha angle, were measured on post-bleed days (PBDs) 1, 3, 5, 7, and 10.
• Correlations were drawn between TEG parameters, functional outcomes, and various laboratory markers (CBC, ESR, hs-CRP, fibrinogen, d-dimer).

Main Results:

• MA was significantly elevated in SAH patients compared to controls from PBD 3 to PBD 10 (P < 0.05).
• Elevated G values were also observed in SAH patients compared to controls across the same PBDs (P < 0.05).
• Multivariate analysis revealed that elevated MA was independently associated with poor outcome (OR 39.1, P = 0.006), outperforming CRP, age, and Hunt Hess grade.

Conclusions:

• TEG indices, particularly MA, are significantly associated with poor outcomes in patients with SAH.
• Elevated MA suggests a platelet-mediated hypercoagulable state following SAH.
• MA demonstrates a stronger association with SAH outcomes than traditional biomarkers and is independent of patient age and clinical severity (Hunt Hess grade).