(678) Assessing the Utility of TEG Platelet Mapping in Spontaneous Intracerebral Hemorrhage Management

Introduction: In the United States, around 10% of the strokes that occur each year are intracerebral hemorrhage (ICH). While use of reversal agents is well-defined in ICH management guidelines, role of viscoelastic hemostatic assays such as thromboelastography (TEG) and platelet mapping (TEG-PM) remains unclear. This study aims to evaluate the impact of the presence of platelet inhibition on TEG-PM on patient outcomes in spontaneous ICH.

Methods: We retrospectively reviewed 215 patients diagnosed with spontaneous intracerebral hemorrhage (ICH) from June 2020 to June 2023. Among these, 98 patients had TEG-PM results. The primary objective was to evaluate discharge outcomes between patients with and without platelet inhibition as identified by TEG-PM. Secondary outcomes included incidence of complications associated with external ventricular drain (EVD) placement and decompressive hemicraniectomy (DHC) in both patient groups. Additionally, we assessed the impact of prior use of anti-platelet therapy on TEG-PM results.

Results: Among 98 patients tested with TEG-PM, 77.6% were TEG positive, indicating platelet inhibition, and 22.4% were TEG negative. Baseline characteristics like age, sex, and race were similar between groups. Discharge outcomes showed no significant difference (p=0.556). In TEG-PM negative group, 22.7% were discharged home and 31.8% to rehab; in TEG-PM positive group, 17.1% went home and 25% to rehab. There were no significant differences in EVD-related complications or DHC; the TEG-PM positive group had a 1% EVD hemorrhage rate (p=1.0, n=1), while the negative group had no complications. TEG-PM did not correlate with prior antiplatelet therapy use (38.1% negative vs 37.3% positive, p=0.815). Platelet transfusion based on TEG-PM did not impact outcomes or complications.

Conclusions: While TEG-PM is well-established in coagulopathy management associated with trauma, organ transplantation, massive transfusions, and mechanical circulatory support, its application in spontaneous ICH remains poorly understood. This analysis shows TEG-PM is not a reliable tool for prediction of patient outcomes or prior-to-admission use of antiplatelet agents. Further research with larger cohorts is needed to clarify TEG-PM's potential role in this context.