Journal article
Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage
Journal of stroke and cerebrovascular diseases, Vol.34(3), 108228
01/08/2025
DOI: 10.1016/j.jstrokecerebrovasdis.2025.108228
PMCID: PMC12247156
PMID: 39793720
Abstract
Intracranial hemorrhage (ICH) is a complication of oral anticoagulation and is associated with significant morbidity and mortality. Clinical need exists for biomarkers to measure anticoagulation in patients with factor Xa inhibitor-associated ICH to assess the hemostatic effect of reversal agents. This study explored the utility of thromboelastography (TEG) to assess anticoagulation in emergency department (ED) patients who received activated prothrombin complex concentrate (aPCC) reversal for factor Xa-inhibitor-associated ICH.BACKGROUNDIntracranial hemorrhage (ICH) is a complication of oral anticoagulation and is associated with significant morbidity and mortality. Clinical need exists for biomarkers to measure anticoagulation in patients with factor Xa inhibitor-associated ICH to assess the hemostatic effect of reversal agents. This study explored the utility of thromboelastography (TEG) to assess anticoagulation in emergency department (ED) patients who received activated prothrombin complex concentrate (aPCC) reversal for factor Xa-inhibitor-associated ICH.This was a prospective, single-center, cohort study in a convenient sample of adult patients presenting to the ED with acute factor Xa-associated ICH. Exclusion criteria included pregnancy, incarceration, polytrauma, hepatic failure, or other known coagulopathic conditions. TEG samples were collected prior to anticoagulation reversal, as well as at 30-minutes, 12-hours, and 24-hours post-reversal. Only patients who received aPCC reversal were included in the final analysis.METHODSThis was a prospective, single-center, cohort study in a convenient sample of adult patients presenting to the ED with acute factor Xa-associated ICH. Exclusion criteria included pregnancy, incarceration, polytrauma, hepatic failure, or other known coagulopathic conditions. TEG samples were collected prior to anticoagulation reversal, as well as at 30-minutes, 12-hours, and 24-hours post-reversal. Only patients who received aPCC reversal were included in the final analysis.Pre-reversal TEG was collected on 10 participants prior to aPCC administration. A significant decrease in TEG R-time was observed at 30 minutes post-aPCC reversal (Beta = -0.91, p = 0.035). R-time increased at 12- and 24-hours post-aPCC reversal to baseline levels. Significant changes were not observed in K-time, clot strength, maximum amplitude, or coagulation index.RESULTSPre-reversal TEG was collected on 10 participants prior to aPCC administration. A significant decrease in TEG R-time was observed at 30 minutes post-aPCC reversal (Beta = -0.91, p = 0.035). R-time increased at 12- and 24-hours post-aPCC reversal to baseline levels. Significant changes were not observed in K-time, clot strength, maximum amplitude, or coagulation index.TEG R-time decreases acutely after anticoagulation reversal with aPCC and rebounds at 12- and 24-hours post-reversal. TEG R-time may serve as a potential sensitive biomarker of the residual anticoagulation activity of factor Xa inhibitors in patients with ICH that undergo anticoagulation reversal with aPCCs.CONCLUSIONSTEG R-time decreases acutely after anticoagulation reversal with aPCC and rebounds at 12- and 24-hours post-reversal. TEG R-time may serve as a potential sensitive biomarker of the residual anticoagulation activity of factor Xa inhibitors in patients with ICH that undergo anticoagulation reversal with aPCCs.
Details
- Title: Subtitle
- Thromboelastography may assess the effect of anticoagulation reversal in intracranial hemorrhage
- Creators
- A Zepeski - University of Iowa, University of Iowa Health CareB A Faine - University of IowaM Ghannam - University of Iowa, NeurologyH M Olalde - University of IowaL Wendt - University of IowaA Naidech - Northwestern UniversityN M Mohr - University of IowaE C Leira - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of stroke and cerebrovascular diseases, Vol.34(3), 108228
- DOI
- 10.1016/j.jstrokecerebrovasdis.2025.108228
- PMID
- 39793720
- PMCID
- PMC12247156
- NLM abbreviation
- J Stroke Cerebrovasc Dis
- ISSN
- 1532-8511
- eISSN
- 1532-8511
- Publisher
- ELSEVIER; AMSTERDAM
- Grant note
- NIH StrokeNet Research Trainee Program at Iowa: U24NS107247 Department of Emergency Medicine at the University of Iowa Carver College of Medicine
Funding for this project was provided by the NIH StrokeNet Research Trainee Program at Iowa (U24NS107247) and a seed grant from the Department of Emergency Medicine at the University of Iowa Carver College of Medicine.
- Language
- English
- Date published
- 01/08/2025
- Academic Unit
- Neurology; Epidemiology; Emergency Medicine; Iowa Neuroscience Institute; Pharmacy Practice and Science; Anesthesia; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984772247202771
Metrics
7 Record Views