Evidence map›Paper›PMID 40670714›Full record

ArticleNeurocritical care2025

The Discriminative Ability of ROTEM for Delayed Cerebral Ischemia and Poor Outcome Following Aneurysmal Subarachnoid Hemorrhage.

M A Tjerkstra, H Labib, B A Coert, R Post, W P Vandertop, D Verbaan, N P Juffermans

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Article in Neurocritical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Haemorrhage, hypercoagulability and ischaemia: Evolution of brain injury after aneurysmal subarachnoid haemorrhage.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026
    Review
  2. Microthrombi and hypercoagulability's contribution to delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism · 2026
    Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

M A TjerkstraDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands. m.a.tjerkstra@amsterdamumc.nl.ORCID 0000-0001-9060-3435
H LabibDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
B A CoertDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
R PostDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
W P VandertopDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
D VerbaanDepartment of Neurosurgery, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands.
N P JuffermansLaboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThe prediction of delayed cerebral ischemia (DCI) and poor clinical outcome following aneurysmal subarachnoid hemorrhage (aSAH) is an unmet clinical need to improve on stratification of patients. DCI and poor clinical outcome following aSAH have been associated with hypercoagulability as detected by viscoelastic testing. This study assesses temporal alterations in rotational thromboelastography (ROTEM) coagulation profiles and the discriminative ability of ROTEM parameters for DCI and poor clinical outcome following aSAH.

methodsROTEM parameters were measured on admission, days 3-5, and days 9-11 after aSAH and compared between patients with and without DCI, radiological DCI, and poor 6-month clinical outcome as per modified Rankin Scale scores 4-6. Receiver operating characteristic curve analyses were used to calculate areas under the curve (AUCs) and determine cutoff values with a sensitivity > 90% for (radiological) DCI and with a specificity > 90% for poor outcome.

resultsOf 160 included patients with aSAH, 31 (19%) had DCI, 16 (10%) had radiological DCI, and 68 (44%) had poor outcome at 6 months. DCI, radiological DCI, and poor clinical outcome were associated with hypercoagulability. The ROTEM parameter with the best discriminative ability for radiological DCI was INTEM clotting time (AUC 0.75) on admission day, with an optimal cutoff value of < 146 s (sensitivity 92%, specificity 47%). For poor outcome, this was increased clot strength by FIBTEM amplitude at 10 minutes (A10, AUC 0.85) on days 3-5, with an optimal cutoff value > 27 mm (specificity 94%, sensitivity 49%).

conclusionsIn this study, ROTEM parameters indicative of increased coagulation had good predictive ability for poor clinical outcome. If independently validated, ROTEM parameters might have the potential to stratify patients with aSAH who may benefit from anticoagulant treatment in future trials with the aim to improve clinical outcome.

Indexed as

Brain IschemiaIntracranial AneurysmOutcome Assessment, Health CareSubarachnoid HemorrhageThrombelastographyAdultAgedFemaleHumansMaleMiddle AgedPrognosisCoagulationDelayed cerebral ischemiaOutcomePrognosticationRotational thromboelastometrySubarachnoid hemorrhage

Identifiers

PMID40670714
PMCPMC12647204

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.