Background and Purpose: Hemorrhagic transformation (HT) has an adverse effect on
the prognosis of patients with acute ischemic stroke, and it is currently known associated with coagulation
system. But the conclusion is not consistent and remains to be identified. The aim of this
study was to investigate the association between coagulation function and spontaneous hemorrhagic
Methods: Patients within 7 days from the onset of ischemic stroke who did not receive reperfusion
therapy (thrombolysis or endovascular treatment) were included between January 2016 and October
2017. Coagulation function indicators, including prothrombin time (PT), activated partial
thromboplastin time (APTT), international normalized ratio (INR), thrombin time (TT) and fibrinogen
(FIB), were tested within 24 h after admission. HT was defined as hemorrhage presented on
follow-up magnetic resonance imaging (MRI) or computed tomography (CT) but not on baseline
CT. We performed binary logistic regression to examine the association between coagulation function
and HT. The coagulation indicators were entered into logistic regression analysis as continuous
variables (per 1-unit/L increase) and four-categorized variables (with data collapsed into quartiles),
Results: A total of 1141 patients were included (mean age, 64 ± 15 years; 63.7% males). 102 patients
experienced HT (8.9%), of whom 14 patients experienced symptomatic HT (sHT, 1.2%).
After adjustment for confounders, TT in the highest quartile is inversely associated with risk of HT
(as continuous variable, odds ratio [OR] 0.85; 95% confidence level [CI] 0.73-0.99, P = 0.042; as
four-categorized variable, OR 0.36, 95% CI 0.18 - 0.7, P = 0.003). Whether as continuous variables
or four-categorized variables, PT, INR, APTT and FIB had no association with HT.
Conclusion: Not the whole process of coagulation function is associated with spontaneous HT.
Prolonged TT, which may indicate an extension of the last step of the coagulation process, is independently
and inversely associated with spontaneous HT in patients with acute ischemic stroke.