Abstract Details

Title Thromboelastography with Platelet Mapping(TEG-PM) is a Sensitive Indicator of Radiographically Confirmed Ischemic Stroke: A Retrospective Analysis.

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 3-034

Objective Evaluate role of TEG-PM in detecting Acute Ischemic Stroke(AIS).

Background Stroke diagnosis relies on imaging studies with lack of testing that predicts stroke. Thromboelastography (TEG) has been useful in bleeding disorders, trauma and has been evaluated in stroke. TEG-PM measures platelet inhibition following addition of specific platelet activators, arachidonic acid (AA) for aspirin or adenosine-5’-diphosphate (ADP) for clopidogrel. While TEG-PM can monitor anti-platelet therapy in selected patients, its role in ischemic stroke is not understood.

Design/Methods Retrospective review of patients diagnosed with AIS at a University Level 1 stroke center was performed. Patients with TEG-PM within 24-hours-of-admission were separated into cohorts based on presence or absence of radiographically confirmed AIS. Radiographic studies were reviewed blindly without knowledge of TEG studies. Study characteristics evaluated included demographics, comorbidities, MRI-studies; CT-Head-Alberta-Stroke Program Early CT Score (ASPECT) score and NIHSS. Fischer exact test, T-test, ROC curve and ANOVA were used for statistical analysis.

Results 91 patients were included with 58 (64%) having radiographically confirmed AIS. 77 (85%) subjects had >26% platelet inhibition by TEG-PM, despite no documented use of aspirin or clopidogrel. Higher ADP inhibition was seen in moderate and severe stroke by NIHSS and ASPECT scoring. Mean ADP inhibition without AIS was 14.82 ± 14.1 compared to 59.33 ± 37.0 in AIS (p=0.0254). ROC curve demonstrated AUC: 0.878 with a value of ≥ 26% ADP inhibition considered significant (p=0.023) for AIS with 89%-sensitivity and 80%-specificity.

Conclusions Our findings support ADP inhibition may be involved in the pathophysiology of AIS. TEG-PM is highly sensitive for the presence of a radiographically confirmed stroke. TEG-PM may be a useful diagnostic tool in evaluation of stroke, similar to its use in other settings, particularly trauma, and should be considered to be a routine test in initial stroke evaluation. More research is needed to better understand the variability seen in platelet inhibition and its relationship to AIS.

Authors/Disclosures
Niraj A. Arora, MD (University of Missouri, Columbia) PRESENTER	Dr. Arora has nothing to disclose.
	No disclosure on file
	No disclosure on file
Ahmer Asif, MD	Dr. Asif has nothing to disclose.

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