A systematic review on viscoelastic testing in subarachnoid haemorrhage patients

Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Neurosciences, Amsterdam, the Netherlands. Electronic address: m.a.tjerkstra@amsterdamumc.nl. Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Amsterdam UMC location University of Amsterdam, Department of Neurosurgery, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Amsterdam Neurosciences, Amsterdam, the Netherlands. Amsterdam Neurosciences, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Amsterdam UMC location University of Amsterdam, Department of Intensive Care, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands. Amsterdam Neurosciences, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Laboratory of Experimental Intensive Care and Anesthesiology, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands; Department of Intensive Care, OLVG Hospital, Oosterpark 9, 1091 AC, Amsterdam, the Netherlands.

World Neurosurgery. 2023
Abstract
OBJECTIVES Bleeding and thromboembolic complications frequently occur following subarachnoid haemorrhage (SAH) and substantially contribute to poor outcome. Viscoelastic testing could be used for detection of coagulopathies following SAH. This review summarizes literature on the utility of viscoelastic testing to detect coagulopathy in SAH patients and explores whether viscoelastic parameters are associated with SAH-related complications and clinical outcome. MATERIALS AND METHODS PUBMED, EMBASE and Google Scholar were systematically searched on August 18(th), 2022. Two authors independently selected studies which performed viscoelastic testing in SAH patients and assessed the quality of studies using the Newcastle Ottawa Scale or a previously published framework for quality assessment. Data was meta-analysed if methodologically possible. RESULTS The search yielded 19 studies (1160 SAH patients). Pooling of data including all relevant studies was not possible for any of the outcome measurements due to methodological differences. Thirteen of 19 studies evaluated the association of coagulation profiles and SAH, of which 11 studies showed a hypercoagulable profile. Rebleeding was associated with platelet dysfunction, deep venous thrombosis was associated with faster clot initiation and both delayed cerebral ischemia and poor outcome were associated with increased clot strength. CONCLUSIONS This explorative review shows that SAH patients frequently have a hypercoagulable profile. TEG- and ROTEM-parameters are associated with rebleeding, delayed cerebral ischemia, deep venous thrombosis and poor clinical outcome after SAH, however more research on the subject is needed. Future studies should focus on determining the optimal time frame and cut-off values for TEG or ROTEM to predict these complications.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine