Thromboelastography for prediction of hemorrhagic transformation in patients with acute ischemic stroke

Thromboelastography (TEG) provides a rapid assessment of the hemostatic processes of a patient in emergency settings. There are limited data on TEG as a predictive tool for hemorrhagic transformation in patients with acute ischemic stroke. We investigated whether TEG values on admission could predict hemorrhagic transformation in patients with acute ischemic stroke.

TEG was performed prospectively in 772 patients who satisfied the criteria of the critical pathway for acute stroke that have neurologic symptoms in 6 h at the emergency department between March and December 2018. After excluding 114 patients, 628 patients were evaluated, and finally, 205 patients with acute ischemic stroke were included. The primary outcome is hemorrhagic transformation, defined as the presence of blood in brain on follow-up imaging study and secondary outcome is neurological deterioration, defined as a 2-point increase on the National Institutes of Health Stroke Scale (NIHSS) within 72 h of stroke onset.

Of the 205 ischemic stroke patients (mean age 67 ± 13 years, 66.3% male), hemorrhagic transformation was identified in 28 (13.7%) patients, and neurological deterioration was occurred in 24 (11.7%), and both events in 9 (4.4%). The TEG value of R (reaction time) <5 min was significantly higher in patients with hemorrhagic transformation than in patients without hemorrhagic transformation (81.1% vs. 60.5%, p = 0.027), and based on multivariable analysis, this was an independent predictor of hemorrhagic transformation (odds ratio 3.215 [95% confidence interval: 1.153-8.969]).

In patients with acute ischemic stroke, TEG value of R < 5 min can identify patients who have an increased risk of hemorrhagic transformation during hospitalization.