Thrombelastography Suggests Hypercoagulability in Patients with Renal Dysfunction and Intracerebral Hemorrhage Kevin Meier, MD,* Daniel M. Saenz, MS,* Glenda L. Torres, MS,* Chunyan Cai, PhD,† Mohammed H. Rahbar, PhD,† Mark McDonald, MD,‡ Stuart Fraser, MD,‡ Elena Espino, BS,* H. Alex Choi, MD,* Nancy J. Edwards, MD,* Kiwon Lee, MD,* James C. Grotta, MD,§ and Tiffany R. Chang, MD* Background: The objective of this study was to quantify coagulopathy using thrombelastography (TEG) in patients with renal dysfunction and intracerebral hemorrhage (ICH). Methods: We reviewed patients admitted with spontaneous ICH between November 2009 and May 2015. TEG was performed at the time of admission. Creatinine clearance (CCr) was calculated using the Cockroft–Gault equation. Patients were divided into 2 groups based on normal (CCr ≥ 90) or reduced renal function (CCr < 90). Multivariable regression models were conducted to compare the differences of TEG components. Results: A total of 120 patients were in- cluded in the analysis. The normal CCr group was younger (56.1 versus 62.3 years, P < .01), was more often male (73.6% versus 53.7%, P = .03), and had higher mean admission hemoglobin (14.2 versus 13.2 mEq/L, P < .01) than the reduced renal function group. The 2 groups were similar with respect to antiplatelet or antico- agulant use, coagulation studies, and baseline ICH volume. Following multivariate analysis, the reduced renal function group was found to have shorter K (1.5 versus 2.2 min, P = 004), increased angle (66 versus 62.2 degrees, P = .04), increased MA (67.3 versus 62.3, P = .02), and increased G (11.3 versus 9.9 dynes/cm 2 , P = .04) compared with the normal group. Mortality, poor functional outcome (modified Rankin Scale score 4-6), hematoma enlargement, hospital length of stay, and sur- gical interventions were not different between the 2 groups. Conclusions: Patients with ICH and reduced CCr display faster clotting rate and increased clot strength, suggesting that patients with renal dysfunction present with a relatively hyper- coagulable state based on TEG parameters thought to reflect platelet activity. Key Words: Thombelastography—intracerebral hemorrhage—stroke—coagulation— acute kidney injury—kidney disease—uremia. © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. From the *Department of Neurosurgery; †Department of Internal Medicine, University of Texas Health Science Center, Houston, Texas; ‡Department of Neurology, University of Virginia, Charlottesville, Virginia; and §Memorial Hermann Hospital, Texas Medical Center, Houston, Texas. Received August 9, 2016; revision received May 2, 2017; accepted December 19, 2017. Conflict of interest: Dr. Chang has received research support from Haemonetics Inc., the manufacturer of thrombelastography. Haemonetics has donated the supplies for thrombelastography testing. Address correspondence to Tiffany R. Chang, MD, Department of Neurosurgery, University of Texas Health Science Center at Houston, 6431 Fannin St., MSB 7.154, Houston, TX 77030. E-mail: Tiffany.R.Chang@uth.tmc.edu. 1052-3057/$ - see front matter © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.12.026 ARTICLE IN PRESS Journal of Stroke and Cerebrovascular Diseases, Vol. ■■, No. ■■ (■■), 2017: pp ■■–■■ 1