434: PREDICTIVE VALUE OF TEG WITH PLATELET MAPPING ON HEMATOMA EXPANSION IN SPONTANEOUS ICH

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Introduction: Spontaneous intracerebral hemorrhage (ICH) accounts for about 10% of strokes in the United States and is linked to high morbidity and mortality. Hematoma expansion independently predicts poor outcomes. Thromboelastography with platelet mapping (TEG-PM) has shown predictive value for hematoma expansion in traumatic ICH, but its role in spontaneous ICH is unclear. This research seeks to fill the gap in current literature by investigating the relationship between TEG-PM findings and hematoma expansion, potentially leading to more targeted interventions. Methods: This retrospective cohort study assessed the predictive value of TEG-PM, focusing on arachidonic acid (AA) and adenosine diphosphate (ADP) inhibition, for hematoma expansion in spontaneous ICH patients. Patients with spontaneous ICH who received TEG-PM and an initial CT scan within 6 hours of symptom onset between January 2018 and April 2024 were included. Patients taking anticoagulants or antiplatelet agents, those with traumatic ICH, vascular malformations, brain tumors, or coagulopathies were excluded. The primary outcome was the predictive value of TEG-PM findings on hematoma expansion. Secondary objectives included in-hospital mortality rate, incidence of hematoma expansion, and incidence of hemostatic medication administration. Results: A total of 117 patients with spontaneous ICH met inclusion criteria and were included in the final analysis. The median age was 62 years (IQR, 54–72), and 72 patients (61.5%) were male. Hematoma expansion occurred in 19 patients (16.2%). Platelet function parameters measured by TEG-PM, specifically AA% inhibition (6.0% vs. 9.9%, p = 0.37) and ADP% inhibition (16.1% vs. 21.0%, p = 0.77), did not differ significantly between those with and without expansion. Use of hemostatic agents like desmopressin (12.0%) and tranexamic acid (18.8%) was similar. In-hospital mortality occurred in 17.1%, with no significant difference by expansion status (21.1% vs. 16.3%; p = 0.62). Conclusions: TEG-PM parameters did not predict hematoma expansion in this cohort. The low expansion rate may have limited the predictive value of TEG-PM. These results suggest limited utility of TEG-PM to guide management in spontaneous ICH patients without overt platelet dysfunction or anticoagulation.

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