(O-B5) Thromboelastography Differences in Geriatric Patients with Traumatic Intracranial Hemorrhage by Unfavorable or Favorable Outcomes

Objectives: In geriatric patients with traumatic ICH, are there differences in TEG results between patients with unfavorable outcomes and those who had favorable outcomes?

Background: Intracranial hemorrhage (ICH) is prevalent in the geriatric population due to polypharmacy, comorbidities, and age-related alterations in physiology that may result in head injury. Thromboelastography (TEG) is a global test of coagulation that assesses clot formation, strength, and lysis. There are limited studies evaluating TEG in geriatric patients with traumatic ICH.

Methods: Patients aged ≥ 65 years presenting to two level-1 trauma centers with head trauma resulting in acute ICH over the course of a year were prospectively followed. Those with a TEG performed were included. Chart review included demographics, comorbidities, medications, and hospital disposition. Patients were stratified by outcome of unfavorable (death or discharge from hospital to hospice) or favorable (all others). TEG component values were compared between groups.

Results: 324 patients were included who sustained an ICH after head trauma with TEG performed. Average age was 81.9 years (SD 8.1) and 40.7% were female. Patients with unfavorable outcomes were more likely to have a coagulation disorder (3.6% vs 0.4%, p=0.023) or congestive heart failure (16.1% vs 4.1%, p=0.001). All other comorbidities were similar among patients. Anticoagulant use and antiplatelet use were similar between unfavorable and favorable groups (4.9% on warfarin, 17.3% on direct-acting oral anticoagulants, 51.5% on aspirin, and 20.4% on P2Y12 inhibitor). The only TEG values that were significantly different between patients with unfavorable and favorable outcomes were % inhibition adenosine diphosphate (ADP) and maximum amplitude (MA)-ADP (37.7% vs 27.6%; difference 10.1; 95% CI: 3.0 to 17.3; p=0.006) and (46.6mm vs 52.7mm; difference -6.1; 95% CI: -10.5 to -1.7; p=0.007), respectively. The other TEG values were similar among patients.

Conclusions: Geriatric patients with acute traumatic ICH who have increased % inhibition of ADP or decreased MA-ADP are more likely to have unfavorable outcomes. This is due to weaker clot strength, which this study could not determine the cause of. In these patients, consideration should be given to treatments that promote improved platelet function at the time of ICH diagnosis, to potentially prevent unfavorable outcomes.

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Funding (Optional): FMMJUA