TY - JOUR
T1 - Real-time monitoring of intravenous thrombolysis in acute ischemic stroke using rotational thromboelastometry
T2 - a feasibility pilot study
AU - Tinchon, Alexander
AU - Freydl, Elisabeth
AU - Fitzgerald, Robert D
AU - Duarte, Christina
AU - Weber, Michael
AU - Calabek-Wohinz, Bernadette
AU - Waiß, Christoph
AU - Oberndorfer, Stefan
N1 - Funding Information:
We thank Dr. Oliver Friedrich from the Research Unit of the Karl Landsteiner University of Health Sciences and Dr. Andreas Calatzis from Munich for their valuable scientific advice during the development of the manuscript. We also thank Warren Fulton for proof-reading. The authors want to appreciate the contribution of NÖ Landesgesundheitsagentur, legal entity of University Hospitals in Lower Austria, for providing the organizational framework to conduct this research.
Publisher Copyright:
© 2022, The Author(s).
PY - 2022/11
Y1 - 2022/11
N2 - INTRODUCTION: Rotational thromboelastometry (ROTEM) records whole blood coagulation in vitro. Data on dynamic changes of clot patterns during intravenous thrombolysis (IVT) in acute ischemic stroke is scarce. We investigated the feasibility of ROTEM as a potential point-of-care assessment tool for IVT.METHODS: In this prospective pilot study, patients with acute stroke symptoms received IVT. Whole blood coagulation was tracked on the ROTEM analyzer. Blood samples were analyzed before, and then 2, 15, 30 and 60 min after beginning IVT. In vitro clots (iCLs) were described by their maximum clot firmness (MCF), the time needed to reach MCF (MCF-t), as well as the area under the curve (AR10). National Institutes of Health Stroke Scale (NIHSS) was used as early clinical outcome parameter.RESULTS: We analyzed 288 iCLs from 12 patients undergoing IVT. In all iCLs, an early fibrinolysis (91% within the first 10 min) was detected during IVT. Three different curve progression patterns were observed: a low-responder pattern with a continuous clot increase, a high-responder pattern with a sustained clot decrease or total clotting suppression and an intermediate-responder pattern with alternating clot characteristics. There was a difference among these groups in early clinical outcome (AR10 and MCF each p = 0.01, MCF-t p = 0.02, Kruskal-Wallis Test).CONCLUSION: The fibrinolysis patterns determined using ROTEM allow for the monitoring of IVT in patients with acute ischemic stroke. This pilot study found a correlation between the in vitro fibrinolysis patterns and early clinical outcomes. These findings support a potential for individualization of IVT in the future.
AB - INTRODUCTION: Rotational thromboelastometry (ROTEM) records whole blood coagulation in vitro. Data on dynamic changes of clot patterns during intravenous thrombolysis (IVT) in acute ischemic stroke is scarce. We investigated the feasibility of ROTEM as a potential point-of-care assessment tool for IVT.METHODS: In this prospective pilot study, patients with acute stroke symptoms received IVT. Whole blood coagulation was tracked on the ROTEM analyzer. Blood samples were analyzed before, and then 2, 15, 30 and 60 min after beginning IVT. In vitro clots (iCLs) were described by their maximum clot firmness (MCF), the time needed to reach MCF (MCF-t), as well as the area under the curve (AR10). National Institutes of Health Stroke Scale (NIHSS) was used as early clinical outcome parameter.RESULTS: We analyzed 288 iCLs from 12 patients undergoing IVT. In all iCLs, an early fibrinolysis (91% within the first 10 min) was detected during IVT. Three different curve progression patterns were observed: a low-responder pattern with a continuous clot increase, a high-responder pattern with a sustained clot decrease or total clotting suppression and an intermediate-responder pattern with alternating clot characteristics. There was a difference among these groups in early clinical outcome (AR10 and MCF each p = 0.01, MCF-t p = 0.02, Kruskal-Wallis Test).CONCLUSION: The fibrinolysis patterns determined using ROTEM allow for the monitoring of IVT in patients with acute ischemic stroke. This pilot study found a correlation between the in vitro fibrinolysis patterns and early clinical outcomes. These findings support a potential for individualization of IVT in the future.
KW - Feasibility Studies
KW - Fibrinolysis
KW - Humans
KW - Ischemic Stroke
KW - Pilot Projects
KW - Prospective Studies
KW - Stroke/drug therapy
KW - Thrombelastography
KW - Thrombolytic Therapy
UR - http://www.scopus.com/inward/record.url?scp=85134519225&partnerID=8YFLogxK
U2 - 10.1007/s00415-022-11271-z
DO - 10.1007/s00415-022-11271-z
M3 - Journal article
C2 - 35852602
SN - 0340-5354
VL - 269
SP - 6129
EP - 6138
JO - Journal of Neurology
JF - Journal of Neurology
IS - 11
ER -