Coagulation Differences Between Deep And Lobar Intracerebral Hemorrhage Detected By Thromboelastography.

Introduction: Despite smaller baseline hematoma volumes, deep primary intracerebral hemorrhage (ICH) is known to have worse clinical outcomes and preliminary evidence of more hematoma expansion compared to lobar ICH. This is not thought to be related to differences in functional coagulation as prior studies have not identified differences in traditional, plasma-based coagulation tests between these locations. We investigated for clotting differences between deep and lobar ICH using Thromboelastography (TEG: whole-blood coagulation assessment). Methods: Clinical, radiographic and laboratory data was prospectively collected between 2009-2018 for primary ICH patients admitted to University of Texas Health Sciences Center at Houston. Deep and lobar ICH patients, without preceding history of anticoagulation use or coagulopathy on admission testing, who received admission TEG and traditional plasma coagulation tests were included for analysis. Patients receiving hemorrhage reversal transfusions prior to TEG were excluded. Multivariable linear regression assessed the association of ICH location with functional coagulation tests after adjusting for age, sex, NIHSS, and baseline hematoma volume. Results: Of 207 ICH patients included for analysis, there were 154 (74%) deep and 53 (26%) lobar ICH. Deep ICH patients were significantly younger (mean: 56 vs 68 years), had higher admission systolic blood pressures (mean: 200 vs 182mmHg) and smaller admission hematoma volumes (median: 16.2 vs 28.7mL) than lobar ICH patients. Deep ICH had longer TEG R times (mean: 5.1 vs 4.4 minutes) indicating a slower and less optimal time to clot formation compared to lobar ICH. After controlling for potential confounders, the adjusted mean R times continued to be longer in deep compared to lobar ICH by 0.57 minutes (95% CI 0.02-1.11, p=0.04). Conclusions: Our findings suggest that there may be functional coagulation differences detected with whole blood coagulation testing between deep and lobar ICH. Further work is needed to determine whether whole blood coagulation testing to assess coagulopathy after ICH should play a role in hemorrhage reversal treatment paradigms.