Coagulation Differences Detectable in Deep and Lobar Primary Intracerebral Hemorrhage Using Thromboelastography

Area of Science:

• Neurology
• Hematology
• Medical Diagnostics

Background:

• Intracerebral hemorrhage (ICH) presents with distinct radiographic and clinical outcomes based on location (deep vs. lobar).
• Pilot studies indicate potential functional coagulation differences between deep and lobar ICH, detectable via whole blood coagulation testing.

Purpose of the Study:

• To validate functional coagulation differences between deep and lobar ICH using thromboelastography (TEG) in a larger patient cohort.
• To investigate interlocation coagulation variations in primary ICH patients.

Main Methods:

• Prospective data collection from 2009-2018 for primary ICH patients at a tertiary referral center.
• Analysis of deep and lobar ICH patients who underwent admission TEG, excluding those with prior anticoagulant use or coagulopathy.
• Linear regression models adjusted for hematoma size, age, sex, and stroke severity to assess ICH location's association with TEG and plasma coagulation tests.

Main Results:

• 154 deep ICH and 53 lobar ICH patients were analyzed; deep ICH patients were younger with smaller hematoma volumes.
• Adjusted analysis revealed significantly longer TEG R times (indicating slower clot formation) in deep ICH compared to lobar ICH (P=0.04).
• No significant differences were observed in other TEG parameters or plasma-based coagulation tests between the groups.

Conclusions:

• Longer clot formation times in deep ICH suggest relative coagulopathy compared to lobar ICH, corroborating previous findings.
• Further research is needed to understand the mechanisms behind these coagulation differences.
• The findings may inform future treatment strategies for coagulopathy in ICH patients based on lesion location.