title: Thrombelastography detects possible coagulation disturbance in patients with intracerebral hemorrhage with hematoma enlargement.
abstract: OBJECTIVE
  Intracerebral hemorrhage (ICH) has high morbidity, and hematoma enlargement (HE) causes worse outcome. Thrombelastography (TEG) measures the dynamics of clot formation and dissolution, and might be useful for assessing bleeding risk. We used TEG to detect changes in clotting in patients with and without HE after ICH.
  
  
  METHODS
  This prospective study included 64 patients with spontaneous ICH admitted from 2009 to 2013. TEG was performed within 6 hours of symptom onset and after 36 hours. Brain imaging was obtained at baseline and at 36±12 hours, and HE was defined as total volume increase>6 cc or >33%. TEG was also obtained from 57 controls.
  
  
  RESULTS
  Compared with controls, patients with ICH demonstrated faster and stronger clot formation; shorter R and delta (P<0.0001) at baseline; and higher MA and G (P<0.0001) at 36 hours; 11 patients had HE. After controlling for potential confounders, baseline K and delta were longer in HE+ compared with HE- patients, indicating that HE+ patients had slower clot formation (P<0.05). TEG was not different between HE+ and HE- patients at 36 hours.
  
  
  CONCLUSIONS
  TEG may detect important coagulation changes in patients with ICH. Clotting may be faster and stronger in immediate response to ICH, and a less robust response may be associated with HE. These findings deserve further investigation.
authors.affiliation: From the Department of Neurology, The University of Texas Medical School, Houston (J.K.-C., E.W., A.E., J.W., A.H., M.M., S.A.P., J.A.-L., C.T., E.P., J.C.G.); and Center for Clinical and Translational Sciences, University of Texas at Houston (C.C., M.H.R.).
authors.forename: Jorge
authors.initials: J
authors.lastname: Kawano-Castillo
authors.forename: Eric
authors.initials: E
authors.lastname: Ward
authors.forename: Andrea
authors.initials: A
authors.lastname: Elliott
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wetzel
authors.forename: Amanda
authors.initials: A
authors.lastname: Hassler
authors.forename: Mark
authors.initials: M
authors.lastname: McDonald
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Parker
authors.forename: Joancy
authors.initials: J
authors.lastname: Archeval-Lao
authors.forename: Chad
authors.initials: C
authors.lastname: Tremont
authors.forename: Chunyan
authors.initials: C
authors.lastname: Cai
authors.forename: Evan
authors.initials: E
authors.lastname: Pivalizza
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000368:Aged; D001778:Blood Coagulation Disorders / Q000150:complications / Q000175:diagnosis*; D002543:Cerebral Hemorrhage / Q000150:complications / Q000175:diagnosis*; D000077144:Clopidogrel; D003627:Data Interpretation, Statistical; D005260:Female; D006406:Hematoma / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D018401:Sample Size; D012959:Socioeconomic Factors; D013916:Thrombelastography / Q000379:methods*; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: blood coagulation factors; cerebral hemorrhage; thrombelastography