Abstract Number: PB0083
Meeting: ISTH 2021 Congress
Theme: Coagulation and Natural Anticoagulants » Critical Care and Perioperative
Background: Subarachnoid Aneurysmal Hemorrhage (SAH) evolves towards prothrombotic state that might influence development of SAH complications. Analysis of global thrombin generation (TG) by Calibrated Automatic Thrombinography (CAT) and clot-formation kinetics by thromboelastometry (ROTEM) could offer new insights on SAH.
Aims: Assessment of changes in patients’ hemostatic profile after SAH.
Methods: A pilot, prospective, single-center and observational study was performed to assess changes in the global hemostatic profile on days (D) 1, 3 and 7 after SAH by CAT (TG peak) and ROTEM (maximun clot firmness by fibTEM test [MCF]). Platelet count, fibrinogen (FIB) and C-reactive protein (CRP) were also determined.
Results: Data of 15 patients ≥ 18 years of age (60% women) were analysed. Vasospasm, late neurological damage (LND), and death were observed in 28%, 20%, and 13% of patients, respectively (Table 1). CRP was out of range after SAH, increasing along D1-D7, indicating an stepped development of a proinflammatory state. In D1 and D3, prothrombotic state due to an increment in TG was observed (Table 2). On the contrary, ROTEM showed a later fibrinogen-dependent prothrombotic state on D3 (MFC vs FIB; r = 0.703; p = 0.035) and D7 (MCF vs FIB; r = 0.900; p <0.001). No patient was treated with anticoagulants during the study. We could not find any relationship between global hemostatic status and incidence of death, vasospasm or LND.
| Parameter | Patients (N=15) | Controls (N=29) | p-value |
| Age (year) (mean ± SD) | 56 ± 12 | 51 ± 8 | 0.070 |
| Sex female (%) | 60 | 59 | 1.000 |
| Vasospasm (%) | 28 | – | – |
| LND (%) | 20 | – | – |
| IHM (%) | 13 | – | – |
Clinical and demographic data. LN= Late neurological damage; IHM= In-hospital mortality
| Parameter | N | Day | Patients | Controls | p-value |
| Thrombin Peak (nM) | 15 | 1 | 344 [274-377] | 229 [136-338] | 0.006* |
| 14 | 3 | 296 [235-434] | 0.021* | ||
| 10 | 7 | 219 [177-271] | 0.700 | ||
| MCF-fibTEM (mm) | 13 | 1 | 16 [14-21] | 9-25N | – |
| 13 | 3 | 26 [24-40]¥ | |||
| 13 | 7 | 28 [21-80]¥ | |||
| Fibrinogen (mg/dL) | 15 | 1 | 318 [286-407] | 200-400N | – |
| 14 | 3 | 544 [408-683]¥ | |||
| 14 | 7 | 473 [402-643]¥ |
Thrombin generation, thromboelastometry and proinflammatory markers; median [25-75 percentile]; *statistically significant; N=Normal range; ¥=median value out of normal range
Conclusions: After SAH, early hypercoagulable state develops due to increments in TG. In D3 and D7, though normalization of TG was observed, the prothrombotic status continues at the expense of fibrinogen-dependent increment of the clot MCF probably linked to the development of an acute proinflammatory state. Wider studies are required to determine mechanisms involved in the origin of the SAH-related prothrombotic state and their relationship with the development of vasospasm, LND and death in SAH.
To cite this abstract in AMA style:
Nanwani K, Fernandez I, Monzón E, Justo R, Butta N, Quintana M. Changes in the Global Hemostatic Profile after Subarachnoid Aneurismatic Hemorrhage [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/changes-in-the-global-hemostatic-profile-after-subarachnoid-aneurismatic-hemorrhage/. Accessed November 28, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/changes-in-the-global-hemostatic-profile-after-subarachnoid-aneurismatic-hemorrhage/