Thromboelastometry Shows Early Hypercoagulation in Patients with Spontaneous Subarachnoid Hemorrhage

Area of Science:

• Neuroscience
• Hematology
• Critical Care Medicine

Background:

• Hemostasis is critical for outcomes following spontaneous subarachnoid hemorrhage (SAH).
• Early coagulation changes after SAH remain under-investigated, impacting understanding of disease progression and treatment.

Purpose of the Study:

• To investigate coagulation alterations in the acute phase following spontaneous aneurysmal SAH.
• To elucidate the underlying mechanisms contributing to these coagulation changes.

Main Methods:

• 46 patients with aneurysmal SAH underwent blood sampling at admission and 24 hours post-onset.
• Thromboelastometry (ROTEM) and assays for thrombin generation, thrombin-antithrombin complex, fibrinogen, and factor XIII were performed.
• Data were compared against a gender-matched healthy control group.

Main Results:

• SAH patients displayed significantly higher clot firmness (EXTEM, FIBTEM) and platelet maximum clot elasticity upon admission compared to controls.
• Elevated thrombin-antithrombin complex levels were observed, with a trend towards higher endogenous thrombin potential.
• While fibrinogen and factor XIII levels were within normal ranges, they increased 24 hours post-SAH, as did endogenous thrombin potential.

Conclusions:

• Patients with SAH present with a hypercoagulable state at admission, persisting for 24 hours.
• Increased clot firmness may be attributed to enhanced platelet function, evidenced by increased platelet maximum clot elasticity.
• Coagulation factor levels (fibrinogen, factor XIII) were normal but showed a trend of increase, suggesting complex hemostatic alterations.