高凝在缺血性脑卒中伴钝性脑血管损伤中的作用

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-08-24 DOI:10.1016/j.jocn.2025.111572

Dayna M. Carlson , Matthew K. Mcintyre , Joseph Nugent , Justin L. Regner , Mitchell B. Sally , Cassie A. Barton , James Wright

{"title":"高凝在缺血性脑卒中伴钝性脑血管损伤中的作用","authors":"Dayna M. Carlson , Matthew K. Mcintyre , Joseph Nugent , Justin L. Regner , Mitchell B. Sally , Cassie A. Barton , James Wright","doi":"10.1016/j.jocn.2025.111572","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing coagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via coagulation profile, including thromboelastography (TEG) and coagulation studies, on ischemic stroke incidence following BCVI.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 h of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI. Receiver operating curves (ROC) with area under the curve (AUC) were constructed for incident strokes.</div></div><div><h3>Results</h3><div>38 patients met inclusion criteria with 22 (57.9 %) being male with a median age of 51 (20.25). The most common mechanism of injury was motor vehicle collision occurring in 17 (44.7 %) patients. Seven (18.4 %) suffered ischemic strokes in the distribution of BCVI. The stroke group were found to have significantly decreased R value (3.7 [2.45–4.15] vs. 4.3 [3.75–4.8], <em>p</em> = 0.040), fibrinogen (197.9 (62.7) vs. 282.1 (103.9), <em>p =</em> 0.049), and aPTT (23.5 [22.8–26.4] vs. 27.8 [26.2–35.0], <em>p</em> = 0.039). On ROC analysis, R value (AUC = 0.75), fibrinogen (AUC = 0.75), and PTT (AUC = 0.76) had high discriminatory value for incident stroke while the highest Biffl grade did not (AUC = 0.48).</div></div><div><h3>Conclusions</h3><div>In this cohort of patients with blunt cerebrovascular injury, those with evidence of hypercoagulation experienced an increased incidence of BCVI-related ischemic stroke in the distribution of injury. While larger studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier initiation of anti-thrombotic prophylaxis.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111572"},"PeriodicalIF":1.8000,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The role of hypercoagulability in ischemic stroke associated with blunt cerebrovascular injury\",\"authors\":\"Dayna M. Carlson , Matthew K. Mcintyre , Joseph Nugent , Justin L. Regner , Mitchell B. Sally , Cassie A. Barton , James Wright\",\"doi\":\"10.1016/j.jocn.2025.111572\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing coagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via coagulation profile, including thromboelastography (TEG) and coagulation studies, on ischemic stroke incidence following BCVI.</div></div><div><h3>Methods</h3><div>This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 h of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI. Receiver operating curves (ROC) with area under the curve (AUC) were constructed for incident strokes.</div></div><div><h3>Results</h3><div>38 patients met inclusion criteria with 22 (57.9 %) being male with a median age of 51 (20.25). The most common mechanism of injury was motor vehicle collision occurring in 17 (44.7 %) patients. Seven (18.4 %) suffered ischemic strokes in the distribution of BCVI. The stroke group were found to have significantly decreased R value (3.7 [2.45–4.15] vs. 4.3 [3.75–4.8], <em>p</em> = 0.040), fibrinogen (197.9 (62.7) vs. 282.1 (103.9), <em>p =</em> 0.049), and aPTT (23.5 [22.8–26.4] vs. 27.8 [26.2–35.0], <em>p</em> = 0.039). On ROC analysis, R value (AUC = 0.75), fibrinogen (AUC = 0.75), and PTT (AUC = 0.76) had high discriminatory value for incident stroke while the highest Biffl grade did not (AUC = 0.48).</div></div><div><h3>Conclusions</h3><div>In this cohort of patients with blunt cerebrovascular injury, those with evidence of hypercoagulation experienced an increased incidence of BCVI-related ischemic stroke in the distribution of injury. While larger studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier initiation of anti-thrombotic prophylaxis.</div></div>\",\"PeriodicalId\":15487,\"journal\":{\"name\":\"Journal of Clinical Neuroscience\",\"volume\":\"141 \",\"pages\":\"Article 111572\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2025-08-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Clinical Neuroscience\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0967586825005454\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825005454","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

摘要

脑卒中是钝性脑血管损伤（BCVI）后发生的一种罕见但具有潜在破坏性的结果。评估凝血状态可以为开始抗血栓治疗提供更精确的风险分层。我们试图通过凝血分析（包括血栓弹性成像（TEG）和凝血研究）来评估高凝状态对BCVI后缺血性卒中发生率的影响。方法本回顾性研究评估了2010年至2023年在三级创伤中心住院的BCVI患者。纳入入院24小时内接受TEG治疗的患者。主要终点是BCVI分布的缺血性卒中。建立了带有曲线下面积（AUC）的受试者工作曲线（ROC）。结果38例患者符合纳入标准，其中男性22例（57.9%），中位年龄51岁（20.25岁）。17例（44.7%）患者最常见的损伤机制是机动车碰撞。7例（18.4%）发生缺血性脑卒中。卒中组R值（3.7[2.45-4.15]比4.3 [3.75-4.8],p = 0.040）、纤维蛋白原（197.9（62.7）比282.1 (103.9),p = 0.049）、aPTT（23.5[22.8-26.4]比27.8 [26.2-35.0],p = 0.039）均显著降低。ROC分析显示，R值（AUC = 0.75）、纤维蛋白原（AUC = 0.75）和PTT （AUC = 0.76）对卒中事件具有较高的判别值，而最高Biffl分级（AUC = 0.48）对卒中事件没有较高的判别值。结论在该钝性脑血管损伤患者队列中，有高凝证据的患者在损伤分布中bcvi相关缺血性脑卒中发生率增加。虽然有必要进行更大规模的研究，但在BCVI的初始检查中包括TEG可以帮助识别缺血性卒中高风险患者，从而允许更早地开始抗血栓预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

The role of hypercoagulability in ischemic stroke associated with blunt cerebrovascular injury

Background

Stroke is an infrequent, but potentially devastating outcome that can occur after blunt cerebrovascular injury (BCVI). Assessing coagulation status may allow for more precise risk stratification for initiation of antithrombotic therapy. We sought to evaluate the influence of hypercoagulable state via coagulation profile, including thromboelastography (TEG) and coagulation studies, on ischemic stroke incidence following BCVI.

Methods

This retrospective study evaluated patients with BCVI admitted to a tertiary trauma center between 2010 and 2023. Patients who received TEG within 24 h of admission were included. The primary outcome was ischemic stroke in the distribution of BCVI. Receiver operating curves (ROC) with area under the curve (AUC) were constructed for incident strokes.

Results

38 patients met inclusion criteria with 22 (57.9 %) being male with a median age of 51 (20.25). The most common mechanism of injury was motor vehicle collision occurring in 17 (44.7 %) patients. Seven (18.4 %) suffered ischemic strokes in the distribution of BCVI. The stroke group were found to have significantly decreased R value (3.7 [2.45–4.15] vs. 4.3 [3.75–4.8], p = 0.040), fibrinogen (197.9 (62.7) vs. 282.1 (103.9), p = 0.049), and aPTT (23.5 [22.8–26.4] vs. 27.8 [26.2–35.0], p = 0.039). On ROC analysis, R value (AUC = 0.75), fibrinogen (AUC = 0.75), and PTT (AUC = 0.76) had high discriminatory value for incident stroke while the highest Biffl grade did not (AUC = 0.48).

Conclusions

In this cohort of patients with blunt cerebrovascular injury, those with evidence of hypercoagulation experienced an increased incidence of BCVI-related ischemic stroke in the distribution of injury. While larger studies are necessary, including TEG in the initial workup for BCVI could help identify patients at higher risk for ischemic stroke, allowing for earlier initiation of anti-thrombotic prophylaxis.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.