Clinic Research On Changes Of Platelet Function In Patients With Aneurysmal Subarachnoid Hemorrhage With Rebleeding

Objective We use thromboelastography to detect changes of coagulation, fibrinolysis and platelet function in patients with aneurysmal subarachnoid hemorrhage(aSAH) and the difference in patients with and without rebleeding. And investigating the application of thromboelastography in aSAH patients.Methods It’s a respective study. Patients with aSAH(n=259) and unruptured intracranial aneurysms(UIA)(n=39) admitted to our hospital from Aug. 2014 to Aug. 2015 were enrolled. The clinical data of gender, age, systolic blood pressure, diastolic blood pressure, Hunt-Hess grade, Fisher grade, image features, and platelet count, thromboelastography parameters {R(reaction time)、K(kinetics time)、 Angle(rate of clot formation)、MA(maximum amplitude)、EPL(estimate percent lysis)、LY30(clotlysis)、AA(arachidonic acid) inhibition、ADP(adenosine diphosphate) inhibition } on admission were collected, and compare difference the aSAH group and UIA group with clinical data. Then the correlation of thromboelastography parameters with Hunt-Hess grade and Fisher grade were analyzed. According to the presence or absence of rebleeding, the patients with aSAH were divided into releeding and non-rebleeding groups. Clinical date and thromboelastography parameters were compared between two groups.Results 1.Compared with UIA group, patients with aSAH demonstrated higher ADP inhibition of platelet function(U=1505,P<0.001). The platelet count and TEG values of R, K, Angle, MA, EPL, LY30, AA inhibition of platelet function showed no significant difference when comparing aSAH patients to UIA patients(P>0.05). 2. The distribution of AA inhibition of platelet function for the different Hunt-Hess grade subgroup showed no significant difference(X~2=7.195, P=0.207). ADP inhibition of platelet function and Hunt-Hess grade were statistically related(X~2=53.558,P<0.001). Spearman’s rank correlation analysis showed a highly significant correlation(r=0.387, P < 0.001). AA inhibition for different Fisher subgroup showed significant difference(X~2=17.792,P=0.001), however there was no correlation(r=0.027, P=0.644). ADP inhibition of platelet function and Fisher grade were statistically related(X~2=105.075,P<0.001). Spearman’s rank correlation analysis showed a highly significant correlation(r=0.382, P<0.001). 3. High Fisher grade, Hunt-Hess grade, blood pressure and hematoma exist were more frequent in the rebleeding group(P<0.001,P<0.001,P<0.05,P<0.001) compared with non-rebleeding group; however, there were no differences in gender, age, the location and size of aneurysm(P =0.624,P =0.469,P =0.182,P =0.965). The mortality of rebleeding is absolutely higher(X~2=67.657,P<0.001). 4. Compared with non-rebleeding groups, patients with rebleeding had higher AA and ADP inhibition of platelet function(P =0.047,P <0.001). The platelet count and TEG values of R, K, Angle, MA, EPL, LY30 showed no significant difference(P>0.05).Conclusions 1. aSAH will produce a marked impairment of platelet function on account of the dysfunctional ADP receptor, and the coagulation and fibrinolysis status assessed by TEG remain unchanged. The correlation has been demonstrated between the degree of ADP inhibition and Hunt-Hess grade, and the same to Fisher grade. The more intracranial blood produced by initial bleeding and the more severe of symptom, the more obvious platelet aggregation dysfunction. 3. The obviously diminished platelet function may be associated with rebleeding. Platelet function detected by thrombelastograph may help assess the rebleeding risk in aSAH patients.