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Acute platelet response to aneurysmal subarachnoid hemorrhage depends on severity and distribution of bleeding: an observational cohort study

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Abstract

Microthrombosis after aneurysmal subarachnoid hemorrhage (aSAH) is considered to initiate neuroinflammation, vessel remodeling, and blood-brain barrier leakage. We aimed to verify the hypothesis that the intensity of thrombogenicity immediately after aSAH depends on the amount and distribution of extravasated blood. This observational cohort study included 37 consecutive aSAH patients admitted no longer than 24 h after ictus. Volumes of subarachnoid and intraventricular hemorrhages as well as the Subarachnoid Hemorrhage Early Brain Edema Scale (SEBES) score were calculated in each case. Platelet system status was described by platelet count (PLT), mean platelet volume (MPV), MPV to PLT ratio, and platelet-large cell ratio (P-LCR). Median hemorrhage volume amounted to 11.4 ml (interquartile range 2.8–26.8 ml). Patients with more severe hemorrhage had lower PLT and higher MPV to PLT ratio (ρ =  − 0.49, p < .002; ρ = 0.50, p < .002, respectively). PLT decreased by 2.80 G/l per 1 ml of hemorrhage volume (95% CL 1.30–4.30, p < .001). Further analysis revealed that intraventricular hemorrhage volume was associated with P-LCR and MPV (ρ = 0.34, p < .039; ρ = 0.33, p < .048, respectively), whereas SAH volume with PLT and MPV:PLT ratio (ρ =  − 0.40, p < .013; ρ = 0.41, p < .013, respectively). The odds of unfavorable neurological outcome increased 3.95 times per 1 fl of MPV (95% CI 1.19–13.12, p < .025). MPV was independently correlated with SEBES (ρ = 0.44, p < .006). This study demonstrated that the extent and distribution of aneurysmal subarachnoid hemorrhage are related to different types of acute platelet response, which may be interpreted as local and systemic thrombogenicity. Increased mean platelet volume measured in the acute phase of aSAH may identify patients at risk for unfavorable neurological outcomes and may serve as a marker of early brain injury.

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Data availability

The data that support the findings of this study are available in a public repository (https://doi.org/10.6084/m9.figshare.12771287.v1).

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Acknowledgments

The authors would like to thank Dr. Zbigniew Lewandowski of the Department of Epidemiology and Biostatistics of the Medical University of Warsaw for his helpful advice on the study’s conception.

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Authors and Affiliations

  1. Clinical Department of Neurosurgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland

    Radosław Rzepliński, Kacper Kostyra, Mikołaj Sługocki & Bogusław Kostkiewicz

  2. Department of Descriptive and Clinical Anatomy, Medical University of Warsaw, Warsaw, Poland

    Radosław Rzepliński & Tymon Skadorwa

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Contributions

Conceptualization and methodology: Radosław Rzepliński; Formal analysis and investigation: Radosław Rzepliński, Mikołaj Sługocki, Tymon Skadorwa; Writing—original draft preparation: Radosław Rzepliński, Mikołaj Sługocki; Writing—review and editing: Tymon Skadorwa, Kacper Kostyra; Resources: Kacper Kostyra, Bogusław Kostkiewicz; Supervision: Bogusław Kostkiewicz.

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Correspondence to Radosław Rzepliński.

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All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol was approved by The Ethics Committee of The Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland (Number 109/2018).

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Due to a retrospective analysis of prospectively collected data, additional informed consent was deemed unnecessary. The Ethics Committee of The Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland, has granted permission to conduct the study without obtaining written informed consent.

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Rzepliński, R., Kostyra, K., Skadorwa, T. et al. Acute platelet response to aneurysmal subarachnoid hemorrhage depends on severity and distribution of bleeding: an observational cohort study. Neurosurg Rev 44, 2647–2658 (2021). https://doi.org/10.1007/s10143-020-01444-7

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