title: Prospective evaluation of blood coagulability and effect of treatment in patients with stroke using rotational thromboelastometry.
abstract: BACKGROUND
  Stroke is the second largest cause of death worldwide. Abnormalities in hemostasis play an important role in the pathophysiology of ischemic stroke (IS). These hemostatic defects can be detected using rotational thromboelastometry (ROTEM) as a global method of measuring coagulation. This study assessed the effects of IS on blood hypercoagulability using ROTEM method, before and subsequent to therapeutic interventions.
  
  
  METHODS
  In a prospective observational cohort study, whole blood coagulation using ROTEM, along with full blood count and standard coagulation tests, were compared between patients with IS and an age-matched control group of healthy volunteers. Further assessment took place at 2-4 hours and at 24 hours in the stroke group after therapy to assess the effects of therapeutic intervention.
  
  
  RESULTS
  Seventy-two patients with IS were age-matched to 71 healthy subjects. Clotting time (CT) INTEM (P = .01) and maximum clot firmness (MCF) INTEM (P = .02) were significantly different between stroke patients at baseline and healthy subjects, but this difference disappeared when controlled for by smoking status. There was no association between ROTEM parameters and time from stroke symptom onset or stroke severity as reflected in The National Institute of Health Stroke Scale score. Significant but small changes in the values of MCF-EXTEM, clot formation time (CFT) EXTEM, and alpha-EXTEM CT were observed after therapeutic intervention (thrombolysis or aspirin treatment).
  
  
  CONCLUSIONS
  ROTEM testing does not seem to detect a hypercoagulable state in patients with IS. Nonetheless, some ROTEM parameters had a small change after antiplatelet therapy or thrombolysis.
authors.affiliation: School of Medicine, Swansea University, Swansea, United Kingdom; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, United Kingdom.
authors.forename: Sophia N
authors.initials: SN
authors.lastname: Stanford
authors.affiliation: School of Medicine, Swansea University, Swansea, United Kingdom; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, United Kingdom; The Emergency Department, Morriston Hospital, ABMU Health Board, Swansea, United Kingdom.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Sabra
authors.affiliation: School of Medicine, Swansea University, Swansea, United Kingdom; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lawrence
authors.affiliation: School of Applied Sciences, Cardiff Metropolitan University, Cardiff, United Kingdom.
authors.forename: Roger H K
authors.initials: RH
authors.lastname: Morris
authors.affiliation: NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, United Kingdom; Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom.
authors.forename: Sharon
authors.initials: S
authors.lastname: Storton
authors.affiliation: Department of Stroke Medicine, Morriston Hospital, Swansea, United Kingdom.
authors.forename: Mushtaq
authors.initials: M
authors.lastname: Wani
authors.affiliation: School of Medicine, Swansea University, Swansea, United Kingdom.
authors.forename: Karl
authors.initials: K
authors.lastname: Hawkins
authors.affiliation: College of Engineering, Swansea University, Swansea, United Kingdom.
authors.forename: Phylip Rhodri
authors.initials: PR
authors.lastname: Williams
authors.affiliation: Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
authors.forename: John F
authors.initials: JF
authors.lastname: Potter
authors.affiliation: School of Medicine, Swansea University, Swansea, United Kingdom; NISCHR Haemostasis Biomedical Research Unit, Morriston Hospital, Swansea, United Kingdom; The Emergency Department, Morriston Hospital, ABMU Health Board, Swansea, United Kingdom. Electronic address: phillip.evans2@wales.nhs.uk.
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Evans
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use; D001777:Blood Coagulation / Q000502:physiology*; D002545:Brain Ischemia / Q000097:blood* / Q000188:drug therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D020521:Stroke / Q000097:blood* / Q000188:drug therapy; D013916:Thrombelastography / Q000379:methods*; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Cerebrovascular disease; ROTEM; aspirin; hypercoagulability; stroke; thrombolysis