ABSTRACT NUMBER: ESOC2026A2205 ROTATIONAL THROMBOELASTOMETRY DOES NOT PREDICT HEMORRHAGIC TRANSFORMATION IN ACUTE ISCHEMIC STROKE

Abstract Background and aims Haemorrhagic transformation (HT) is a common complication of acute ischemic stroke (AIS) and is associated with worse functional outcomes. Rotational thromboelastometry (ROTEM) allows rapid bedside assessment of whole-blood coagulation. However, data on ROTEM use in AIS remain inconsistent. We hypothesized that acute-phase ROTEM abnormalities may identify patients at higher risk of HT. Methods AIS patients due to large vessel occlusion and eligible for mechanical thrombectomy were prospectively included. Blood samples collected at femoral artery puncture, within 1 hour after arterial recanalization, and at 24 hours were analysed using real-time ROTEM. HT were assessed by systematic brain imaging at 24 hours and classified according to the Heidelberg criteria. Results Forty-nine patients were included, of whom 31 received intravenous thrombolysis (IVT). Considering maximum clot firmness (MCF), a significant increase in this parameter over time was observed on both EXTEM and FIBTEM assays, regardless of IVT administration. However, this increase was significantly more pronounced in IVT-treated patients and persisted at 24 hours. Despite these acute-phase haemostatic changes, ROTEM parameters were not associated with the occurrence of HT, which was observed in 9 patients. Conclusions To our knowledge, we show for the first time that whole-blood haemostatic assessment using ROTEM at 3 time-points within 24-hours does not predict the occurrence of HT, despite the presence of haemostatic alterations. These findings further support the concept of an active, in situ thromboinflammatory process underlying the occurrence of HT rather than a haemostatic disorder. Conflict of interest The authors declare no conflicts of interest related to this abstract.