Thrombelastography can differentiate ischaemic from haemorrhagic stroke

Abstract

Thrombolysis could be a major step forward in the treatment of acute ischaemic stroke. Early treatment is essential to maximize therapeutic benefit. Imaging by computed tomography (CT) or magnetic resonance imaging is mandatory to exclude haemorrhagic stroke before initiation of therapy. Thrombelastography (TEG), a test of global haemostasis, produces a characteristic tracing over 15–30 min. The potential of TEG to differentiate patients with ischaemic from haemorrhagic stroke was investigated. Fifteen patients with a clinical diagnosis of acute stroke were studied. Fibrinogen levels and lipid profiles were measured, and CT of the brain, coagulation screens and TEG were performed. The CT scans were interpreted by a single radiologist. TEG data were classified as normal (index less than 2), hypercoagulable (index 2–3) or profoundly hypercoagulable (index greater than 3). There was no correlation between any of the parameters studied other than TEG with CT findings. Both patients with a haemorrhagic stroke showed normal findings on TEG. Eleven of the 12 patients with ischaemic stroke were hypercoagulable or profoundly hypercoagulable. TEG is capable of differentiating haemorrhagic from ischaemic stroke. It has the potential to target thrombolytic therapy for those patients most likely to benefit. © 1999 British Journal of Surgery Society Ltd