Abstract A153: Thromboelastography Predicts Hematoma expansion and Disability in Spontaneous Intracerebral Hemorrhage – A Multi-Center Study

Introduction: Hematoma Expansion (HE) is a modifiable cause of disability and death after intracerebral hemorrhage (ICH). Hemostatic biomarkers have the potential to predict HE and identify specific mechanisms of hemostasis for therapeutic intervention; however, many biomarkers, like the International Normalized Ratio (INR), are limited in scope to patients taking warfarin or with hepatic failure. Thromboelastography (TEG) is a rapid, bedside test of clot strength and platelet activity. We prospectively tested the hypothesis that TEG would predict HE and disability outcomes in a large, multi-center cohort, potentially identifying patients for targeted treatment. Methods: We enrolled spontaneous ICH patients at six medical centers across the U.S. between 2019 and 2023. Global hemostasis of whole blood samples was analyzed with TEG. All patients had two CT scans for HE calculation, and a blood draw that occurred prior to follow-up imaging. Patients treated with desmopressin or other interventions that impact coagulation were excluded. Correlations between continuous numerical variables (HE and hemostatic biomarkers) were calculated using Spearman’s correlation. Correlations between the three-month modified Rankin Scale (mRS) and biomarkers were calculated using Kendall’s correlation. Results: We enrolled 82 patients (34.1% women) with a mean age of 61 +/- 13.3 years. None took pre-ICH anticoagulants, and INR was normal. Symptom onset occurred within a median time of 1.8 [1.15 – 4.48] hours before first CT scan imaging, and 5.8 [4.45 – 7.57] hours before blood draw. TEG K, a measure of fibrinogen dependent clot strength, was associated with subsequent HE (rho = 0.19, P =0.048) and the mRS at three months (tau = 0.28, P =0.04). Additionally, TEG MA (tau = -0.32, P = 0.02), a measure of clot strength dependent on platelets, and HE (tau = 0.35, P =0.01) were associated with the mRS at three months. Fibrinogen levels were in the normal range, excluding hypofibrinogenemia as a potential confounder of the association between TEG, hematoma expansion, and outcomes. Conclusions: Hemostatic biomarkers from TEG, particularly related to clot strength and fibrin generation, were associated with subsequent HE and the mRS at three months.