Study On The Value Of TEG-PM In Detecting Platelet Function And Predicting Hematoma Expansion And Prognosis After Cerebral Hemorrhag

Objective: The change of platelet function after intracerebral hemorrhage(ICH)remains unclear.We aimed to find out factors associated with platelet function measured by thromboelastography with platelet mapping(TEG-PM)in ICH patients.Methods: Patients with acute spontaneous ICH admitted to our center from November 2019 to February 2021 were consecutively included.At the same time,a healthy control group was included for comparison.The baseline demographic,clinical characteristics,and imaging indicators were collected.TEG-PM was performed in patients with ICH and control group.The differences in TEG-PM parameters between the ICH group and the control group were analyzed,and the correlation between platelet aggregation function and baseline characteristics and imaging indicators was also analyzed.Results: A total of 142 patients with ICH and 30 healthy controls were enrolled in our study.The median arachidonic acid(AA)inhibition of ICH patients was 33.6(12.7-89.4)%,which was significantly higher than the control group(P=0.003).The median adenosine diphosphate(ADP)inhibition of ICH patients was 57.2(28.1-85.3)%,which was significantly higher than control group(P=0.002).Multivariate analysis revealed the independent and positive correlations between AA inhibition and baseline systolic blood pressure(β=0.227,95%CI 0.130-0.124,P=0.005),as well as baseline hematoma volume(β=0.204,95%CI 0.022-0.386,P=0.012).Higher systolic blood pressure and greater baseline hematoma volume were associated with higher AA inhibition and lower platelet function.The ADP inhibition was associated positively with the baseline hematoma volume(β=0.209,95%CI 0.057-0.361,P=0.012).Larger baseline hematoma volume was related to higher ADP inhibition,indicating lower platelet function.Conclusions: The AA and ADP inhibition after ICH were significantly higher than healthy people,which suggested that platelet function in patients with ICH was significantly impaired.The platelet function is affected by systolic blood pressure and baseline hematoma volume.The higher the systolic blood pressure and the greater the baseline hematoma volume is,the higher the inhibition rate and the lower the platelet function will be.Objective: The mechanism of hematoma expansion after intracerebral hemorrhage(ICH)remains unclear.This study aimed to investigate the relationship between platelet function measured by thromboelastography with platelet mapping(TEG-PM)and hematoma expansion in patients with ICH.Methods: Patients with acute spontaneous ICH admitted to our center from November 2019 to February 2021 were consecutively included.HE was defined as relative growth of more than 33% or an absolute growth greater than 6 ml from initial CT.The ICH patients were further divided into hematoma expansion and non-hematoma expansion subgroups.Clinical data and TEG-PM parameters were compared between the two subgroups.We performed multivariate logistic regression models to assess the association of admission platelet function with hematoma expansion.In addition,a receiver operating characteristic(ROC)curve was conducted to evaluate the accuracy of platelet function in predicting hematoma expansion.Result: Of 142 patients,37(26.1%)suffered hematoma expansion.Higher systolic blood pressure(P=0.005),lower admission GCS score(P<0.001),shorter time to baseline CT scan(P<0.001),larger baseline hematoma volume(P=0.007),higher arachidonic acid(AA)(P<0.001)and adenosine diphosphate(ADP)(P<0.001)inhibition was detected in hematoma expansion subgroup compared to subjects without hematoma expansion.Multivariate logistic regression identified AA and ADP inhibition as significant independent predictors of hematoma expansion.The area under the ROC curves was 0.727 for AA inhibition and 0.721 for ADP inhibition.Optimal threshold for AA inhibition was 41.75%(75.7% sensitivity;67.6% specificity)and ADP inhibition was 65.8%(73.0% sensitivity;66.7% specificity).Conclusion: Early hematoma expansion after ICH is associated with platelet dysfunction,and platelet function measured by TEG-PM can predict the risk of hematoma expansion after ICH.Objective: Hematoma expansion after intracerebral hemorrhage(ICH)is associated with platelet function,but the relationship between platelet function and prognosis remains indeterminate.This study aimed to investigate the relationship between platelet function measured by thromboelastography with platelet mapping(TEG-PM)and prognosis in patients with ICH.Methods: Patients with acute spontaneous ICH admitted to our center from November 2019 to February 2021 were consecutively included.Functional outcome was scored with the modified Rankin Scale(m RS)at 3 months.Poor functional outcome was defined as a dichotomized m RS score of 3-6.The ICH patients were further divided into good outcome and poor outcome subgroups.Clinical data and TEG-PM parameters were compared between the two subgroups.We performed multivariate logistic regression models to assess the association of admission platelet function with prognosis.In addition,a receiver operating characteristic(ROC)curve analysis was carried out to investigate the predictive value of platelet function for poor outcome.A mediation analysis was undertaken todetermine causal associations among platelet function,hematoma expansion,and outcome.Result: Of 142 patients,eighty-eight patients(62.0%)with ICH had unfavorable outcome.Old age,low admission GCS score,intraventricular hemorrhage,large baseline hematoma volume,and high AA and ADP inhibition were associated with unfavorable outcome.The multivariate logistic analysis showed that the AA and ADP inhibition remained independent predictors of unfavorable outcome in patients with ICH.The area under the ROC curves was 0.713 for AA inhibition and 0.711 for ADP inhibition.Optimal threshold for AA inhibition was 26.5%(73.9% sensitivity;72.2% specificity)and ADP inhibition was 62.4%(60.2% sensitivity;75.9% specificity).The mediation analysis showed that the effect of higher platelet inhibition with poor outcomes was mediated through hematoma expansion.Conclusion: Platelet function measured by TEG-PM can predict the outcome in patients with ICH.The correlation between high platelet inhibition and poor outcome was mediated through hematoma expansion.