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Thrombin Generation in Patients with Non-traumatic Intracerebral Hemorrhage

1University of Debrecen, Faculty of Medicine, Division of Clinical Laboratory Sciences, Debrecen, Hungary, 2University of Debrecen, Faculty of Medicine, Department of Neurology, Debrecen, Hungary, 3University of Debrecen, Faculty of Medicine, Department of Radiology, Debrecen, Hungary, 4MTA-DE Cerebrovascular and Neurodegenerative Research Group, Debrecen, Hungary

Abstract Number: PB0106

Meeting: ISTH 2020 Congress

Theme: Arterial Thromboembolism » Cerebrovascular Disorders

Background: Non-traumatic intracerebral hemorrhage (ICH) accounts for 10-15% of all strokes and results in a higher rate of mortality as compared to ischemic strokes.

Aims: In the IRONHEART study, we aimed to find out whether the thrombin generation assay (TGA) could predict outcomes in patients with ICH.

Methods: In this prospective, observational study, 57 consecutive patients with ICH of a single stroke center and 120 healthy controls were enrolled. Exclusion criteria included aneurysm rupture, cancer, liver or kidney failure, hemorrhagic diathesis or anticoagulant therapy. Detailed clinical and laboratory investigations were performed on admission. Baseline traditional cerebrovascular risk factors were registered in both groups. TGA was performed on stored platelet poor plasma obtained on admission. Bleeding volume was estimated in patients based on CT performed on admission, day 1 and 2. Short- and long-term outcomes of ICH were defined at 14 days and 3 months post-event according to NIHSS and the modified Rankin Scale (mRS), respectively. All patients or relatives and controls provided written informed consent.

Results: Endogen thrombin potential (ETP) was significantly higher in patients as compared to controls (1719±358 vs. 1495±271 nM*min, respectively, p< 0.0001). Peak thrombin was significantly higher, while lag time and time-to-peak parameters were significantly longer in patients vs. controls. Elevated ETP was associated with worse long-term outcomes (mRS 0-1:1586±299 vs. mRS 2-5:1983±476 and mRS 6:1765±288 nM*min, p=0.019). Peak thrombin showed similar, significant association (mRS 0-1:321.1±55.9 vs. mRS 2-5:411.4±75.5 and mRS 6:308.1±148.8 nM, p=0.022). Time-to-peak showed a modest, significant negative correlation with admission intracerebral bleeding volume (r=-0.29, p=0.040).

Conclusions: Patients with ICH showed increased thrombin generation as compared to controls, which might be explained by the presence of more cerebrovascular risk factors in patients. Elevated ETP and peak thrombin was associated with unfavorable outcomes, indicating that TGA might be useful to predict outcomes in patients with ICH.

Funding: GINOP-2.3.2-15-2016-00043

To cite this abstract in AMA style:

Lóczi L, Árokszállási T, Fekete I, Fekete K, Héja M, Sarkady F, Orbán-Kálmándi R, Tóth J, Csiba L, Bagoly Z. Thrombin Generation in Patients with Non-traumatic Intracerebral Hemorrhage [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/thrombin-generation-in-patients-with-non-traumatic-intracerebral-hemorrhage/. Accessed September 21, 2023.

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