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CONy 2023 | Measuring the hyper- or hypocoagulability status in ICH patients: hemostasis tests

Non-traumatic intracerebral hemorrhage (ICH) accounts for 10–15% of all strokes, leading to a higher mortality rate than ischemic strokes. Pharmacological treatment in ICH is still limited, partly due to an existing knowledge gap in the pathophysiology of intracerebral bleeding and the mechanisms driving hematoma progression. Zsuzsa Bagoly, MD, PhD, University of Debrecen, Debrecen, Hungary, debates whether monitoring hypo-or hypercoagulability status in ICH patients could be helpful in personalizing antithrombotic management and could aid clinical decision-making. Patients with hemorrhagic stroke have a significantly higher risk of in-hospital venous thromboembolism (VTE) than patients with ischemic strokes. Although in-hospital VTE is independently associated with poor outcomes, decision-making on anticoagulation evokes debate among clinicians because anticoagulants may increase the risk of recurrent ICH and hematoma expansion. Hemostasis tests to predict the outcome of intracerebral hemorrhages, such as thrombin generation assay and D-dimer test, could be helpful and simplify clinical decisions. However, studies evaluating those tools are scarce, and more research is needed. This interview took place at the 17th World Congress on Controversies in Neurology (CONy) in Dubrovnik, Croatia.

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