Abstract Number: PB0885
Meeting: ISTH 2021 Congress
Theme: Platelet Disorders, von Willebrand Disease and Thrombotic Microangiopathies » Platelet Function Disorders, Acquired
Background: Intracerebral hemorrhage (ICH) has significant morbidity and mortality. Improving patient outcomes with ICH depends on our ability to recognize hematoma expansion (HE). The altered hemostatic functions have not yet been clearly defined. We hypothesize that changes in coagulation parameters, platelet function and fibrinolytic system are present and can provide biomarkers for the progress of HE, and furthermore may lead to targeted interventions to improve outcomes.
Aims: Determine hemostatic mechanisms occurring in ICH patients with HE using platelet function, coagulation activation and fibrinolysis assays.
Methods: Patients with acute ICH are studied after consent within the first 12 hours onset. Platelet function, coagulation factors and fibrinolysis activity are measured by thromboelastography (TEG) and ROTEM viscoelastic assays (VEA). Platelet function is also tested by PFA-100, and VerifyNow Aspirin and P2Y12 point-of-care (POC) assays. Coagulation activation is measured by Thrombin Generation Assay and Tissue Factor activity. Fibrinolysis is assayed by Plasmin/antiplasmin (PAP) complex, Fibrinogen, D-Dimer and PAI-1 activity.
Results: Seventeen patients who presented with acute ICH and hypertension were consented. Eleven had basal ganglia or thalamus lesions; 4 cortical bleeding; 1 pontine and 1 cerebellar hemorrhage. Platelet dysfunction with inhibited ADP-induced aggregation was shown by TEG platelet mapping in 11/17 patients, with mean inhibition of 33.1% (range 6.8 – 96.5). Platelet dysfunction by POC assay was observed in 13 patients and was not accounted for by antiplatelet medication. EXTEM assay showed increased fibrinolysis in 6 cases. Five of 10 patients tested had elevated D-dimer, mean 1142 ng/mL D-DU (range 443 to 3040). Fibrinogen levels were normal in 5 available cases.
Conclusions: This is the first evidence of platelet dysfunction and fibrinolysis in patients with acute ICH using VEA and POC testing. Platelet dysfunction, coagulation activation and fibrinolysis are investigated as potential biomarkers for ICH hematoma expansion.
To cite this abstract in AMA style:
Lindholm P, Kwaan H, Weiss I, Naidech A. Frequent Platelet Dysfunction and Fibrinolysis in Patients with Intracerebral Hemorrhage [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/frequent-platelet-dysfunction-and-fibrinolysis-in-patients-with-intracerebral-hemorrhage/. Accessed October 2, 2023.« Back to ISTH 2021 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/frequent-platelet-dysfunction-and-fibrinolysis-in-patients-with-intracerebral-hemorrhage/