A Systematic Review of Viscoelastic Testing in Patients with Subarachnoid Hemorrhage

World Neurosurg. 2023 Jul:175:102-112.e5. doi: 10.1016/j.wneu.2023.03.108. Epub 2023 Mar 31.


Objective: Bleeding and thromboembolic complications frequently occur after subarachnoid hemorrhage (SAH) and substantially contribute to poor outcome. Viscoelastic testing could be used for detection of coagulopathies after SAH. This review summarizes literature on the usefulness of viscoelastic testing to detect coagulopathy in patients with SAH and explores whether viscoelastic parameters are associated with SAH-related complications and clinical outcome.

Methods: PubMed, Embase, and Google Scholar were systematically searched on August 18, 2022. Two authors independently selected studies that reported viscoelastic testing in patients with SAH and assessed the quality of studies using the Newcastle-Ottawa Scale or a previously reported framework for quality assessment. Data were meta-analyzed if methodologically possible.

Results: The search yielded 19 studies (1160 patients with SAH). Pooling of data including all relevant studies was not possible for any of the outcome measurements because of methodological differences. Thirteen of 19 studies evaluated the association of coagulation profiles and SAH, of which 11 studies showed a hypercoagulable profile. Rebleeding was associated with platelet dysfunction, deep venous thrombosis was associated with faster clot initiation, and both delayed cerebral ischemia and poor outcome were associated with increased clot strength.

Conclusions: This explorative review shows that patients with SAH frequently have a hypercoagulable profile. Thromboelastography (TEG) and rotational thromboelastometry (ROTEM) parameters are associated with rebleeding, delayed cerebral ischemia, deep venous thrombosis, and poor clinical outcome after SAH; however, more research on the subject is needed. Future studies should focus on determining the optimal time frame and cutoff values for TEG or ROTEM to predict these complications.

Keywords: Clinical outcome; Coagulation; Delayed cerebral ischemia; Fibrinolysis; Hemostasis; Stroke; Subarachnoid hemorrhage; Viscoelastic testing.

Publication types

  • Systematic Review
  • Review

MeSH terms

  • Blood Coagulation Disorders* / diagnosis
  • Blood Coagulation Disorders* / etiology
  • Blood Coagulation Tests
  • Brain Ischemia* / complications
  • Humans
  • Subarachnoid Hemorrhage* / complications
  • Thrombelastography
  • Thrombophilia* / complications
  • Venous Thrombosis* / complications