Prospective Longitudinal Evaluation of Coagulation with Novel Thromboelastography Technology in Patients after Subarachnoid Hemorrhage - A Pilot Study.

Abstract

There is limited knowledge of whether hypercoagulability is present after subarachnoid hemorrhage (SAH) or about its timing of onset, duration, and severity. To conduct a pilot new generation thromboelastography (TEG) technology (TEG6s) -based and conventional coagulation test-supported longitudinal assessment of coagulation in patients with SAH. We prospectively enrolled non-traumatic SAH patients on admission from May 2015 to May 2016. We performed TEG6s measurements and conventional coagulation tests on days 1, 2, 3, 5, 7, 10 and 14 and compared them to TEG6s parameters in healthy volunteers. We studied 14 patients and 72 TEG6s measurements. Of these patients, 10 (71.4%) were admitted to ICU. Mean age was 57.5 (±14.5), APACHE III score 58.2(±26.6), length of hospital stay of 23 (±11.7) days and mortality was 14.3%. At baseline, conventional coagulation tests were within normal range. However, TEG6s parameters already showed increased coagulability. Thereafter, alpha angle, reaction time, functional fibrinogen level, and maximum amplitude rapidly and significantly increased (p value <0.01) compared with healthy controls. 10 (71.4%) patients demonstrated a > 20% increase in coagulability based on TEG6s parameters from their baseline. Moreover, TEG6s hypercoagulability peaked at day 10 and only showed an initial partial decline towards normal by day 14. Similarly, platelet counts, and fibrinogen levels increase over this period (P<0.01) CONCLUSION: Using TEG6s technology, we found significant and progressive hypercoagulability in 70% of patients, with early dominant contribution from hyperfibrinogenemia and increased fibrin formation and partial contribution from thrombocytosis, beginning on the first day, increasing to peak values by day 10, and then partly declining toward normal by day 14.