Coagulopatía asociada a la hemorragia subaracnoidea aneurismática y sus complicaciones

Introduction: Aneurysmal subarachnoid hemorrhage is a type of stroke that is associated with high rates of mortality and morbidity due to the complications associated with it. Objective: To describe the coagulopathy profile associated with aneurysmal subarachnoid hemorrhage and vasospasm. Methods: A prospective cohort study was carried out, with 15 patients admitted for aneurysmal subarachnoid hemorrhage in the Intensive Care Unit (ICU), at La Paz University Hospital, Madrid, in 2019. Sociodemographic, clinical and analytical variables were analyzed (hematimetry, conventional coagulation and rotational thromboelastometry) at three times (day 1, day 3-4 and day 7). The analysis of quantitative variables was performed with t-Student or U-Mann-Whitney and comparisons between groups with One-way ANOVA, Kruskal Wallis H, Chi-square or Fisher, as appropriate. A significance level of 0.05 was set. Results: Rotational thromboelastometry showed, in the course of the disease, a decrease in the time of clot formation together with an increase in the alpha angle, maximum clot amplitude, elastic force of the clot, area under the curve and maximum speed of thrombus formation. All of this, together with thrombocytosis and hyperfibrinogenemia, were indicative of hypercoagulability. Compared with those who did not, the patients who developed vasospasm had an increase in platelets on day 7, maximum clot amplitude, clot elastic force, potential thrombodynamic index, and area under the curve, along with a decrease in time clot formation. All this indicated greater hypercoagulability . Conclusions: In aneurysmal subarachnoid hemorrhage, a procoagulant state is evidenced in the viscoelastic study, which cannot be seen in conventional coagulation tests. Vasospasm appears to induce a state of increased hypercoagulability in patients with aneurysmal subarachnoid hemorrhage, and cannot predict its appearance.