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Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke

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Abstract

Thrombelastography (TEG) measures coagulation in venous blood. We hypothesized that TEG, by reflecting clot subtype and ex vivo fibrinolysis, might predict fibrinolytic response to tPA as reflected by rapid clinical improvement or hemorrhagic transformation of the infarct. 171 acute ischemic stroke patients treated with tPA were prospectively enrolled. Venous blood for TEG was drawn before and 10 min after tPA bolus. We measured rapid clinical improvement (RCI = 8 point improvement on NIHSS or total NIHSS of 0, 1 at 36 h), Hemorrhagic transformation (HT = any blood on imaging within 36 h), and hyperdense middle cerebral artery sign (HDMCA = biomarker for erythrocyte-rich clot). Multivariable regression models compared TEG parameters after adjusting for potential confounders. No differences in pre- or post-tPA TEG were found between patients with or without RCI. Also, there was no correlation between TEG and HDMCA. Clotting was slightly prolonged in patients with HT (p = 0.046). We failed to find a robust association between TEG and clinical response to tPA. It is likely that arterial clot lysis is determined by factors unrelated to coagulation status as measured by TEG in the venous circulation. It is unlikely that TEG will be useful to predict clinical response to tPA, but may help predict bleeding.

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Acknowledgments

Supported by Tissue and Data Cores of National Institutes of Health 5P50NS044227-08. Haemonetics Corporation loaned a TEG coagulation analyzer Model 5000 and provided supplies.

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Authors and Affiliations

  1. Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA

    Mark M. McDonald, Jeremy Wetzel, Stuart Fraser, Andrea Elliott, Ritvij Bowry, Jorge F. Kawano-Castillo, Navdeep Sangha, Jessica Messier, Amanda Hassler, Joancy Archeval-Lao, Stephanie A. Parker & Tiffany R. Chang

  2. Department of Internal Medicine, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA

    Chunyan Cai & Mohammad H. Rahbar

  3. Department of Anesthesiology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA

    Evan G. Pivalizza

  4. Department of Neurosurgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA

    Tiffany R. Chang

  5. Memorial Hermann Hospital, 6411 Fannin St, Houston, TX, 77030, USA

    James C. Grotta

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  1. Mark M. McDonald
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  2. Jeremy Wetzel
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  3. Stuart Fraser
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Correspondence to James C. Grotta.

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Dr. Grotta receives consulting fees from Haemonetics.

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McDonald, M.M., Wetzel, J., Fraser, S. et al. Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke. J Thromb Thrombolysis 41, 505–510 (2016). https://doi.org/10.1007/s11239-015-1280-9

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