title: Thrombelastography does not predict clinical response to rtPA for acute ischemic stroke.
abstract: Thrombelastography (TEG) measures coagulation in venous blood. We hypothesized that TEG, by reflecting clot subtype and ex vivo fibrinolysis, might predict fibrinolytic response to tPA as reflected by rapid clinical improvement or hemorrhagic transformation of the infarct. 171 acute ischemic stroke patients treated with tPA were prospectively enrolled. Venous blood for TEG was drawn before and 10 min after tPA bolus. We measured rapid clinical improvement (RCI = 8 point improvement on NIHSS or total NIHSS of 0, 1 at 36 h), Hemorrhagic transformation (HT = any blood on imaging within 36 h), and hyperdense middle cerebral artery sign (HDMCA = biomarker for erythrocyte-rich clot). Multivariable regression models compared TEG parameters after adjusting for potential confounders. No differences in pre- or post-tPA TEG were found between patients with or without RCI. Also, there was no correlation between TEG and HDMCA. Clotting was slightly prolonged in patients with HT (p = 0.046). We failed to find a robust association between TEG and clinical response to tPA. It is likely that arterial clot lysis is determined by factors unrelated to coagulation status as measured by TEG in the venous circulation. It is unlikely that TEG will be useful to predict clinical response to tPA, but may help predict bleeding.
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Mark M
authors.initials: MM
authors.lastname: McDonald
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Wetzel
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Stuart
authors.initials: S
authors.lastname: Fraser
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Andrea
authors.initials: A
authors.lastname: Elliott
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Ritvij
authors.initials: R
authors.lastname: Bowry
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Kawano-Castillo
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Chunyan
authors.initials: C
authors.lastname: Cai
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Navdeep
authors.initials: N
authors.lastname: Sangha
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: Messier
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Hassler
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Joancy
authors.initials: J
authors.lastname: Archeval-Lao
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Parker
authors.affiliation: Department of Internal Medicine, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Rahbar
authors.affiliation: Department of Anesthesiology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Evan G
authors.initials: EG
authors.lastname: Pivalizza
authors.affiliation: Department of Neurology, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.|Department of Neurosurgery, University of Texas Health Science Center at Houston, 7000 Fannin St, Houston, TX, 77030, USA.
authors.forename: Tiffany R
authors.initials: TR
authors.lastname: Chang
authors.affiliation: Memorial Hermann Hospital, 6411 Fannin St, Houston, TX, 77030, USA. James.C.Grotta@uth.tmc.edu.
authors.forename: James C
authors.initials: JC
authors.lastname: Grotta
mesh_terms: D000208:Acute Disease; D002545:Brain Ischemia / Q000097:blood / Q000188:drug therapy; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced; D006801:Humans; D008297:Male; D008954:Models, Biological; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000188:drug therapy; D013916:Thrombelastography; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage* / Q000009:adverse effects
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Haemocoagulation; Stroke; Thromboelastography; Thrombolysis; Thrombus