Association of Rotational Thromboelastometry Parameters with Hematoma Expansion After Spontaneous Intracerebral Hemorrhage

Abstract Background In patients with spontaneous intracerebral hemorrhage (ICH), hematoma expansion (HE) is a strong and potentially modifiable cause of poor outcome and, therefore, an important target for therapeutic interventions in the acute phase of ICH. To date, no blood biomarkers are available to predict HE. We aimed to explore the potential association of coagulation parameters assessed by rotational thromboelastometry (ROTEM) with HE after spontaneous ICH. Methods We retrospectively analyzed the data of 182 consecutive patients admitted to our Comprehensive Stroke Center for spontaneous ICH. The inclusion criteria were as follows: admission within 24 h of symptom onset, ROTEM assay performed within 24 h of symptom onset, and follow-up computed tomography (CT) performed between 24 and 36 h from baseline CT. Clinical, radiological, and laboratory data were collected. The primary outcome measure was HE, defined as significant (> 33% and/or > 6 ml) hemorrhage growth at follow-up CT. Results HE was found in 14 (20%) of the 70 patients included in the study. In the multivariable logistic regression analysis, ICH volume at baseline (Odds Ratio [OR] 1.066, 95% Confidence Interval [CI] 1.007–1.128, p = 0.027), time from onset to baseline CT (OR 0.967, 95% CI 0.940–0.995, p = 0.022), and ROTEM Lysis Index at 60 min (LI60) in the EXTEM test (OR 0.626, 95% CI 0.398–0.983, p = 0.042) were the variables independently associated with HE. The model demonstrated a good overall fit (Nagelkerke R 2 = 0.59). Conclusions ROTEM LI60 in the EXTEM test might be a blood biomarker associated with HE in the acute phase of spontaneous ICH. Together with established predictors, such as baseline ICH volume and shorter time to imaging, ROTEM could help identify patients at higher risk of HE.