Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms |
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| Affiliation: | 1. Department of Neurosurgery, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan;2. Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan;1. Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom;2. Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom;3. Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia;4. Liverpool Heart and Chest Hospital, Liverpool, United Kingdom;5. Department of Clinical Medicine, Aalborg University, Aalborg, Denmark;6. TriNetX LLC, London, United Kingdom;7. Department of Medicine, Whiston Hospital, St Helens and Knowsley Teaching Hospitals NHS Trust, United Kingdom;1. Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan;2. Clinical Research Center National Hospital Organization, 2-21 Higashigaoka, Meguro-ku, Tokyo, 152-8621, Japan;3. Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji-shi, Tokyo, 192-0392, Japan;1. Department of Neurology and Neurosciences, Helsinki University Hospital and University of Helsinki, Helsinki, Finland;2. Department of Radiology, Helsinki University Hospital and Helsinki University, Helsinki, Finland;1. Yozgat Bozok University, Faculty of Medicine, Department of Emergency Medicine, Yozgat, Turkey;2. University Medical Center Groningen, Department of Emergency Medicine, Groningen, The Netherlands;1. Schools of Nursing, University of Michigan, Ann Arbor, Michigan;2. Medicine, University of Michigan, Ann Arbor, Michigan;3. Public Health, University of Michigan, Ann Arbor, Michigan;1. Associate Professor, Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India;2. Head of Department, Department of Infectious Disease, Government Medical College, Thiruvananthapuram, Kerala, India;3. Assistant Professor in Neurology, Government Medical College, Thiruvananthapuram, Kerala, India.;4. Professor in ENT, Government Medical College, Thiruvananthapuram, Kerala, India;5. Associate Professor, Department of Microbiology, Government Medical College, Thiruvananthapuram, Kerala, India;6. Assistant Professor, Department of Endocrinology, Government Medical College, Thiruvananthapuram, Kerala, India;7. Professor in Neurosurgery, Government Medical College, Thiruvananthapuram, Kerala, India;8. Professor in Ophthalmology, Regional Institute of Ophthalmology, Government Medical College, Thiruvananthapuram, Kerala, India;9. Associate Professor in SPM, Government Medical College, Thiruvananthapuram, Kerala, India;10. Professor and Head in Neurology, Government Medical College, Thiruvananthapuram, Kerala, India |
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| Abstract: | ObjectivesMethods for assessing platelet function in patients with neurovascular disease remain controversial and poorly studied. This study aimed to assess associations between thromboelastography 6s (TEG6s) measurements and postoperative ischemic complications in patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization.MethodsEighty-four patients with UIAs taking a combined aspirin and clopidogrel protocol were retrospectively reviewed from January 2021 to May 2022. Blood samples were obtained for TEG6s to assess platelet function on the day of coil embolization. To identify acute ischemic complications, diffusion-weighted imaging (DWI) was performed within 24 h after coil embolization. Multivariate logistic regression analysis was conducted to identify potential risk factors for postoperative positive DWI (DWI (+)) lesions.ResultsForty-three of the 84 patients (51%) with DWI (+) lesions were identified. Compared with patients without DWI (+) lesions, Adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MAADP) was significantly higher (53.6 mm [Interquartile range (IQR): 48.3–58.3 mm] vs 46.7 mm [IQR: 36.8–52.2 mm]; p=0.001) and ADP inhibition rate (ADP%) was significantly lower (19% [IQR: 11–31%] vs 31% [IQR: 21–44%]; p=0.001) in DWI (+) patients. Multivariate analysis identified MAADP, ADP%, and procedure time as significant independent predictors of subsequent DWI (+) lesions (odds ratios: 1.07, 0.96, and 1.02, respectively). Based on receiver operating characteristic curve analysis, MAADP >50.9 mm and ADP% <28.8% were associated with postoperative DWI (+) lesions in patients undergoing coil embolization for UIAs.ConclusionsMAADP and ADP% as assessed by TEG6s can offer reliable parameters to predict postoperative ischemic complications after coil embolization of UIAs. Lower MAADP values and higher ADP% may decrease the risk of postoperative ischemic complications. |
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