Functional Coagulation Differences Between Lobar and Deep Intracerebral Hemorrhage Detected by Rotational Thromboelastometry: A Pilot Study
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Lobar intracerebral hemorrhage (ICH) is known to have better clinical outcomes and preliminary evidence of less hematoma expansion compared to deep ICH. No functional coagulation differences between lobar and deep ICH have been identified using traditional plasma-based coagulation tests. We investigated for coagulation differences between lobar and deep ICH using whole-blood coagulation testing (Rotational Thromboelastometry: [ROTEM]).
Clinical, radiographic, and laboratory data were prospectively collected for primary ICH patients enrolled in a single-center ICH study. Patients with preceding anticoagulant use or admission coagulopathy on traditional laboratory testing were excluded. Lobar and deep ICH patients receiving admission ROTEM were analyzed. Linear regression was used to assess the association of ICH location with coagulation test results after adjusting for potential confounders.
There were 12 lobar and 19 deep ICH patients meeting inclusion criteria. Lobar ICH patients were significantly older and predominantly female. Lobar ICH had faster intrinsic pathway coagulation times (139.8 vs 203.2 s; 95% CI − 179.91 to − 45.96; p = 0.002) on ROTEM testing compared to deep ICH after adjusting for age, sex, and hematoma volume. This revealed functional coagulation differences, specifically quicker clot formation in lobar compared to deep ICH. No differences were noted using traditional coagulation testing (prothrombin time/partial thromboplastin time/platelet count).
Our pilot data may suggest that there are functional coagulation differences between lobar and deep ICH identified using ROTEM. Whole-blood coagulation testing may be useful in assessing coagulopathy in ICH patients and in determining reversal treatment paradigms, though further work is needed.
KeywordsIntracerebral hemorrhage Location Lobar Deep Coagulopathy Rotational thromboelastometry
DR contributed to Project design/development, data collection, data analysis, drafting of manuscript. TC contributed to Project design, editing of manuscript. CZ, GW contributed to Project design/development, data collection. ASR, NY, SP, SA, ESC contributed to data collection, editing of manuscript. MSVE, AE, ROF contributed to Project development, editing of manuscript. KD, AB contributed to data analysis, editing of manuscript. JC contributed to Project design/development, data collection, editing of manuscript. EH contributed to Project design, data analysis, editing of manuscript.
Source of Support
Dr. Roh is supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant Number UL1TR001873. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Conflicts of Interest
The authors declare that they have no conflict of interest.
The Columbia University Institutional Review Board approved this study.
Consent was provided by the patient or the family if the patient did not have capacity to consent.