Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage
Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational throm...
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| Veröffentlicht in: | Journal of the neurological sciences 2024-03, Vol.458, p.122943-122943, Article 122943 |
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| creator | Raatikainen, Essi Kiiski, Heikki Kuitunen, Anne Junttila, Eija Huhtala, Heini Kallonen, Antti Ala-Peijari, Marika Långsjö, Jaakko Saukkonen, Johanna Valo, Timo Kauppila, Terhi Raerinne, Sanni Frösen, Juhana Vahtera, Annukka |
| description | Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome.
We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2–3, 4–5, 7–8, and 11–12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome.
DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1–4) on PBDs 4–5 and 7–8, p |
| doi_str_mv | 10.1016/j.jns.2024.122943 |
| format | Article |
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We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2–3, 4–5, 7–8, and 11–12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome.
DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1–4) on PBDs 4–5 and 7–8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4–5 (p < 0.05), PBD 7–8 (p < 0.05), and PBD 11–12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI.
Patients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI.
ClinicalTrials.gov, NCT03985176</description><identifier>ISSN: 0022-510X</identifier><identifier>EISSN: 1878-5883</identifier><identifier>DOI: 10.1016/j.jns.2024.122943</identifier><identifier>PMID: 38422781</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aneurysmal subarachnoid hemorrhage ; Blood Coagulation ; Brain Ischemia ; Cerebral Infarction - complications ; Delayed cerebral ischemia ; Humans ; Intensive care unit ; Outcome ; Prospective Studies ; Subarachnoid Hemorrhage - complications ; Thrombelastography - adverse effects</subject><ispartof>Journal of the neurological sciences, 2024-03, Vol.458, p.122943-122943, Article 122943</ispartof><rights>2024 The Authors</rights><rights>Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c348t-4a759d5306ff5eceea85d9223df6cfca84369f73505b3c8a6e0d715fe5cd73b63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jns.2024.122943$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38422781$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Raatikainen, Essi</creatorcontrib><creatorcontrib>Kiiski, Heikki</creatorcontrib><creatorcontrib>Kuitunen, Anne</creatorcontrib><creatorcontrib>Junttila, Eija</creatorcontrib><creatorcontrib>Huhtala, Heini</creatorcontrib><creatorcontrib>Kallonen, Antti</creatorcontrib><creatorcontrib>Ala-Peijari, Marika</creatorcontrib><creatorcontrib>Långsjö, Jaakko</creatorcontrib><creatorcontrib>Saukkonen, Johanna</creatorcontrib><creatorcontrib>Valo, Timo</creatorcontrib><creatorcontrib>Kauppila, Terhi</creatorcontrib><creatorcontrib>Raerinne, Sanni</creatorcontrib><creatorcontrib>Frösen, Juhana</creatorcontrib><creatorcontrib>Vahtera, Annukka</creatorcontrib><title>Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage</title><title>Journal of the neurological sciences</title><addtitle>J Neurol Sci</addtitle><description>Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome.
We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2–3, 4–5, 7–8, and 11–12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome.
DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1–4) on PBDs 4–5 and 7–8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4–5 (p < 0.05), PBD 7–8 (p < 0.05), and PBD 11–12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI.
Patients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI.
ClinicalTrials.gov, NCT03985176</description><subject>Adult</subject><subject>Aneurysmal subarachnoid hemorrhage</subject><subject>Blood Coagulation</subject><subject>Brain Ischemia</subject><subject>Cerebral Infarction - complications</subject><subject>Delayed cerebral ischemia</subject><subject>Humans</subject><subject>Intensive care unit</subject><subject>Outcome</subject><subject>Prospective Studies</subject><subject>Subarachnoid Hemorrhage - complications</subject><subject>Thrombelastography - adverse effects</subject><issn>0022-510X</issn><issn>1878-5883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kEtr3DAQx0VJaTZJP0AvRcdcvNHDsmVyCqF5QKCXFnIT8mi8q8X2bCW7Id--XjbpMaeB-T-Y-TH2TYq1FLK62q13Y14rocq1VKop9Se2kra2hbFWn7CVEEoVRornU3aW804IUVnbfGGn2pZK1Vau2Pg4QkKfMfC2JwocyG_m3k-RRh4z9zkTRD8t-kuctnxPlPiIc6KeNhF8z2megAbkceT-ILzmYdnmufXJw3akGPgWB0pp6zd4wT53vs_49W2es993P37dPhRPP-8fb2-eCtClnYrS16YJRouq6wwCorcmNErp0FXQgbelrpqu1kaYVoP1FYpQS9OhgVDrttLn7PLYu0_0Z8Y8uSFmwL5fTqQ5O9XoUtVamXqxyqMVEuWcsHP7FAefXp0U7oDZ7dyC2R0wuyPmJfP9rX5uBwz_E-9cF8P10YDLk38jJpch4ggYYkKYXKD4Qf0_KhaQqA</recordid><startdate>20240315</startdate><enddate>20240315</enddate><creator>Raatikainen, Essi</creator><creator>Kiiski, Heikki</creator><creator>Kuitunen, Anne</creator><creator>Junttila, Eija</creator><creator>Huhtala, Heini</creator><creator>Kallonen, Antti</creator><creator>Ala-Peijari, Marika</creator><creator>Långsjö, Jaakko</creator><creator>Saukkonen, Johanna</creator><creator>Valo, Timo</creator><creator>Kauppila, Terhi</creator><creator>Raerinne, Sanni</creator><creator>Frösen, Juhana</creator><creator>Vahtera, Annukka</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20240315</creationdate><title>Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage</title><author>Raatikainen, Essi ; Kiiski, Heikki ; Kuitunen, Anne ; Junttila, Eija ; Huhtala, Heini ; Kallonen, Antti ; Ala-Peijari, Marika ; Långsjö, Jaakko ; Saukkonen, Johanna ; Valo, Timo ; Kauppila, Terhi ; Raerinne, Sanni ; Frösen, Juhana ; Vahtera, Annukka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-4a759d5306ff5eceea85d9223df6cfca84369f73505b3c8a6e0d715fe5cd73b63</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Adult</topic><topic>Aneurysmal subarachnoid hemorrhage</topic><topic>Blood Coagulation</topic><topic>Brain Ischemia</topic><topic>Cerebral Infarction - complications</topic><topic>Delayed cerebral ischemia</topic><topic>Humans</topic><topic>Intensive care unit</topic><topic>Outcome</topic><topic>Prospective Studies</topic><topic>Subarachnoid Hemorrhage - complications</topic><topic>Thrombelastography - adverse effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Raatikainen, Essi</creatorcontrib><creatorcontrib>Kiiski, Heikki</creatorcontrib><creatorcontrib>Kuitunen, Anne</creatorcontrib><creatorcontrib>Junttila, Eija</creatorcontrib><creatorcontrib>Huhtala, Heini</creatorcontrib><creatorcontrib>Kallonen, Antti</creatorcontrib><creatorcontrib>Ala-Peijari, Marika</creatorcontrib><creatorcontrib>Långsjö, Jaakko</creatorcontrib><creatorcontrib>Saukkonen, Johanna</creatorcontrib><creatorcontrib>Valo, Timo</creatorcontrib><creatorcontrib>Kauppila, Terhi</creatorcontrib><creatorcontrib>Raerinne, Sanni</creatorcontrib><creatorcontrib>Frösen, Juhana</creatorcontrib><creatorcontrib>Vahtera, Annukka</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of the neurological sciences</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Raatikainen, Essi</au><au>Kiiski, Heikki</au><au>Kuitunen, Anne</au><au>Junttila, Eija</au><au>Huhtala, Heini</au><au>Kallonen, Antti</au><au>Ala-Peijari, Marika</au><au>Långsjö, Jaakko</au><au>Saukkonen, Johanna</au><au>Valo, Timo</au><au>Kauppila, Terhi</au><au>Raerinne, Sanni</au><au>Frösen, Juhana</au><au>Vahtera, Annukka</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage</atitle><jtitle>Journal of the neurological sciences</jtitle><addtitle>J Neurol Sci</addtitle><date>2024-03-15</date><risdate>2024</risdate><volume>458</volume><spage>122943</spage><epage>122943</epage><pages>122943-122943</pages><artnum>122943</artnum><issn>0022-510X</issn><eissn>1878-5883</eissn><abstract>Patients with aneurysmal subarachnoid hemorrhage (aSAH) have demonstrated increased blood coagulation which is thought to contribute to delayed cerebral ischemia (DCI) and to a worse outcome. Therefore, we sought to determine whether this increased blood coagulation, detectable with rotational thromboelastometry (ROTEM), was associated with DCI and neurological outcome.
We conducted a prospective observational study of 60 consecutive adult aSAH patients. ROTEM's EXTEM and FIBTEM assays and D-dimer were analyzed at admission and post-bleed days (PBDs) 2–3, 4–5, 7–8, and 11–12. ROTEM's clot formation time (CFT) represents the stabilization of the clot, and the maximum clot firmness (MCF) the maximum clot strength. Glasgow Outcome Scale extended (GOSe) at three months determined the neurological outcome.
DCI incidence was 41.7%. EXTEM-CFT was significantly shorter in patients with unfavorable neurological outcome (GOSe 1–4) on PBDs 4–5 and 7–8, p < 0.05, respectively. FIBTEM-MCF was significantly higher in patients with unfavorable neurological outcomes on PBD 4–5 (p < 0.05), PBD 7–8 (p < 0.05), and PBD 11–12 (p < 0.05). EXTEM-CFT decreased, and FIBTEM-MCF rose during the study period in all patients. Patients with unfavorable neurological outcome had a higher D-dimer at all studied time points, p < 0.05. No difference was found in the ROTEM parameters or D-dimer when assessing patients with and without DCI.
Patients were in a state of increased blood coagulation after aSAH, with those with unfavorable neurological outcome being more coagulable than those with favorable outcome. However, increased blood coagulation was not associated with DCI.
ClinicalTrials.gov, NCT03985176</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>38422781</pmid><doi>10.1016/j.jns.2024.122943</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aneurysmal subarachnoid hemorrhage Blood Coagulation Brain Ischemia Cerebral Infarction - complications Delayed cerebral ischemia Humans Intensive care unit Outcome Prospective Studies Subarachnoid Hemorrhage - complications Thrombelastography - adverse effects |
| title | Increased blood coagulation is associated with poor neurological outcome in aneurysmal subarachnoid hemorrhage |
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