PB0028 - Thrombin generation predicts outcomes in patients with non-traumatic intracerebral hemorrhage

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Linda Lóczi

PhD Student
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

Co-Author(s)

Rita Orbán-Kálmándi

Junior research fellow
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary
T�

Tamás Árokszállási

Clinical neurologist, PhD student
University of Debrecen; Faculty of Medicine, Department of Neurology,
Debrecen, Hajdu-Bihar, Hungary
MH

Máté Héja

Resident doctor, PhD student
University of Debrecen; Faculty of Medicine, Department of Neurology,
Debrecen, Hajdu-Bihar, Hungary
IF

István Fekete

Full professor
University of Debrecen, Faculty of Medicine, Department of Neurology
Debrecen, Hajdu-Bihar, Hungary
KF

Klára Fekete

Associate professor
University of Debrecen, Faculty of Medicine, Department of Neurology
Debrecen, Hajdu-Bihar, Hungary
JT

Judit Tóth

Assistant lecturer
University of Debrecen, Faculty of Medicine, Department of Radiology
Debrecen, Hajdu-Bihar, Hungary
LC

László Csiba

Full professor
University of Debrecen; Faculty of Medicine, Department of Neurology and ELKH-DE Neurodegenerative and Cerebrovascular Research Group
Debrecen, Hajdu-Bihar, Hungary
Zsuzsa Bagoly, MD, PhD

Professor (Associate)
Division of Clinical Laboratory Science, Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
Debrecen, Hajdu-Bihar, Hungary

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

Aims: Here we aimed to find out whether the thrombin generation assay (TGA) could predict outcomes in ICH patients.

Methods: In this prospective, observational study 87 consecutive ICH patients (age: 67±12, male/female: 55/32) and 164 healthy controls were included. Exclusion criteria included aneurysm rupture, cancer, liver- or kidney failure or hemorrhagic diathesis. Detailed clinical and laboratory investigations were performed on admission. ICH volume was estimated based on CT performed on admission, day 14 and 90. TGA was performed on stored platelet poor plasma obtained on admission. Lag time, endogen thrombin potential (ETP), peak thrombin, time-to-peak were calculated. Short- and long-term outcomes of ICH were defined at 14 days and 3 months post-event according to the NIHSS and the modified Rankin Scale (mRS), respectively.

Results: Peak thrombin was significantly higher in patients as compared to controls (397.2±93.9 vs. 306.3±85.3 nM, p< 0.0001). Time to peak parameter was significantly longer in patients. Peak thrombin and ETP parameters significantly correlated with estimated ICH volume at day 90 (peak thrombin: r=0.5383; 95%CI:0.2103-0.7574, p=0.0021, ETP: r=0.3838, 95%CI:0.0161-0.6600, p=0.0363), ETP correlated with CRP on admission. Peak thrombin was significantly higher in patients with poor (mRS 2-6) long-term outcome (median [IQR] of mRS 0-1: 402.5 [344.8-473.8] vs. mRS 2-6: 326.4 [294.2-416.1] nM, p= 0.0096). Backward logistic regression analysis revealed that an elevated peak thrombin parameter (>339.1 nM) confers a significant risk for poor long-term outcome (OR:7.27, 95%CI:2.18-24.28, p=0.001).

Conclusion(s): In patients with ICH, the extent of thrombin generation was increased as compared to healthy controls, which might be explained by the presence of higher inflammatory parameters in patients. Peak thrombin measured on admission might be useful to predict outcomes in ICH patients.