BACKGROUND There are radiographic and clinical outcome differences between patients with deep and lobar intracerebral hemorrhage (ICH) locations. Pilot studies suggest that there may be functional coagulation differences between these locations detectable using whole blood coagulation testing. OBJECTIVE To confirm the presence of interlocation functional coagulation differences using a larger cohort of deep and lobar ICH patients receiving whole blood coagulation testing: thromboelastography (TEG; Haemonetics). METHODS Clinical and laboratory data were prospectively collected between 2009 and 2018 for primary ICH patients admitted to a tertiary referral medical center. Deep and lobar ICH patients receiving admission TEG were analyzed. Patients with preceding anticoagulant use and/or admission coagulopathy (using prothrombin time/partial thromboplastin time/platelet count) were excluded. Linear regression models assessed the association of ICH location (independent variable) with TEG and traditional plasma coagulation test results (dependent variable) after adjusting for baseline hematoma size, age, sex, and stroke severity. RESULTS We identified 154 deep and 53 lobar ICH patients who received TEG. Deep ICH patients were younger and had smaller admission hematoma volumes (median: 16 vs 29 mL). Adjusted multivariable linear regression analysis revealed longer TEG R times (0.57 min; 95% CI: 0.02-1.11; P = .04), indicating longer clot formation times, in deep compared to lobar ICH. No other TEG parameter or plasma-based coagulation differences were seen. CONCLUSION We identified longer clot formation times, suggesting relative coagulopathy in deep compared to lobar ICH confirming results from prior work. Further work is required to elucidate mechanisms for these differences and whether ICH location should be considered in future coagulopathy treatment paradigms for ICH.

中文翻译：

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使用血栓弹力图检测深部和大叶原发性脑出血的凝血差异

背景 深部和大叶脑出血 (ICH) 位置的患者的影像学和临床结果存在差异。初步研究表明，使用全血凝血测试可检测到的这些位置之间可能存在功能性凝血差异。目的 使用更大的接受全血凝固测试：血栓弹力图（TEG；Haemonetics）的深部和大叶 ICH 患者队列，确认存在间位功能性凝血差异。方法 前瞻性收集 2009 年至 2018 年期间入住三级转诊医疗中心的原发性 ICH 患者的临床和实验室数据。对接受入院 TEG 的深部和大叶 ICH 患者进行了分析。排除先前使用抗凝剂和/或入院凝血障碍（使用凝血酶原时间/部分凝血活酶时间/血小板计数）的患者。在调整基线血肿大小、年龄、性别和中风严重程度后，线性回归模型评估了 ICH 位置（自变量）与 TEG 和传统血浆凝固测试结果（因变量）的关联。结果 我们确定了 154 名接受 TEG 的深部 ICH 患者和 53 名肺叶 ICH 患者。深部 ICH 患者更年轻，入院血肿体积更小（中位数：16 对 29 毫升）。调整后的多变量线性回归分析显示 TEG R 时间更长（0.57 分钟；95% CI：0.02-1.11；P = .04），表明与大叶 ICH 相比，深部血栓形成时间更长。没有看到其他 TEG 参数或基于血浆的凝血差异。结论 我们确定了更长的凝块形成时间，表明与脑叶 ICH 相比，深部的相对凝血病证实了先前工作的结果。需要进一步的工作来阐明这些差异的机制，以及是否应该在未来的 ICH 凝血病治疗范式中考虑 ICH 的位置。