Abstract Number: PB0083
Meeting: ISTH 2021 Congress
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|
|Thrombin Peak (nM)||15||1||344 [274-377]||229 [136-338]||0.006*|
|MCF-fibTEM (mm)||13||1||16 [14-21]||9-25N||–|
|Fibrinogen (mg/dL)||15||1||318 [286-407]||200-400N||–|
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.
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