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Distinct Coagulation Phenotypes and Long-Term Neurological Outcomes in Post-Cardiac Arrest Syndrome: A Latent Class

Sin Young Park1, Sang Hoon Oh1, Hyo Joon Kim1

  • 1Department of Emergency Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea.

Journal of Clinical Medicine
|February 13, 2026
PubMed

Insights

Post-cardiac arrest syndrome (PCAS) causes varied coagulopathy. A consumptive coagulopathy phenotype, identified in cardiac arrest patients, predicts severe brain injury and poor neurological outcomes.

Area of Science:

  • Neurology
  • Critical Care Medicine
  • Hematology

Background:

  • Post-cardiac arrest syndrome (PCAS) involves systemic ischemia-reperfusion injury and sepsis-like coagulopathy.
  • Coagulopathy in PCAS is heterogeneous, with poorly defined phenotypes and their impact on hypoxic-ischemic brain injury (HIBI).

Purpose of the Study:

  • To identify distinct coagulation phenotypes in PCAS patients using latent class analysis (LCA).
  • To assess the association between these phenotypes and 6-month neurological outcomes after out-of-hospital cardiac arrest (OHCA).

Main Methods:

  • Retrospective analysis of 325 adult OHCA patients treated with targeted temperature management (TTM).
  • Latent class analysis (LCA) utilized coagulation biomarkers (D-dimer, fibrinogen, ATIII, platelets, PT-INR) at admission and 24h post-ROSC.
  • Neurological outcome assessed using Cerebral Performance Category (CPC) at 6 months.

Main Results:

  • Three coagulation phenotypes were identified: Preserved Coagulation (36.9%), Hypercoagulable State (41.5%), and Consumptive Coagulopathy (21.5%).
  • The Consumptive Coagulopathy phenotype showed the lowest gray-to-white matter ratio (GWR) and highest neuron-specific enolase.
  • Consumptive Coagulopathy independently predicted poor neurological outcome (aOR 4.52; 95% CI 2.15-9.48).

Conclusions:

  • PCAS-related coagulopathy is heterogeneous, with distinct phenotypes impacting neurological outcomes.
  • A consumptive coagulopathy phenotype signifies a high-risk subgroup with severe brain injury and poor long-term neurological prognosis.
  • Early identification of this phenotype can aid prognostication and guide phenotype-specific interventions.

Keywords:
Antithrombin IIIcoagulopathyout-of-hospital cardiac arrest

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