# Erythrocyte contribution to coagulopathy and cerebral oxygenation after intracerebral hemorrhage

> **NIH NIH K23** · COLUMBIA UNIVERSITY HEALTH SCIENCES · 2021 · $191,154

## Abstract

PROJECT SUMMARY:
Intracerebral hemorrhage (ICH) carries the highest morbidity and mortality of all stroke subtypes due to the
initial injury and the ongoing bleeding, otherwise known as hematoma expansion (HE), which can occur
afterwards. HE occurs acutely within 24 hours in up to 30% of patients with ICH and is the strongest driver of
worse outcomes in this patient population. Consequently, acute ICH treatment paradigms largely focus on
preventing HE utilizing rapid transfusion based approaches in efforts to improve outcome. However, recent
trials using generalized, rapid transfusion based treatment approaches with coagulation factors or platelet
transfusions to prevent HE have not yielded improved outcomes. This emphasizes a critical knowledge gap in
approaches and treatment targets of HE.
Lower red blood cell (RBC) levels have been associated with bleeding with proposed mechanisms being due
to suboptimal radial displacement of platelets and endothelial binding. While evidence in ICH has consistently
revealed an association of low RBC levels with worse outcomes, this has largely been attributed to impaired
cerebral oxygenation rather than coagulopathy. This extrapolates the associations of low RBC levels with
impaired cerebral oxygenation and poor clinical outcomes from subarachnoid hemorrhage and traumatic brain
injury patient populations as no such studies have yet been performed in ICH. However, there is evidence of
larger baseline hematoma volumes and more recently, increased HE in ICH patients with lower baseline RBC
levels to suggest a role of coagulopathy related to RBC levels in these patients.
The role of RBCs on functional coagulation and cerebral oxygenation after ICH will be investigated via a)
reductionist murine models of anemia, ICH and RBC transfusions and b) a prospective observational human
ICH study evaluating the relationship of RBC levels and RBC transfusions on independent changes in
functional coagulation and cerebral oxygenation. This project will fill an important gap in ICH treatment
paradigms by establishing novel tools to investigate mechanisms of RBC levels on ICH outcomes in order to
ultimately inform future clinical transfusion based treatment approaches in patients with ICH to improve their
outcomes.

## Key facts

- **NIH application ID:** 10127337
- **Project number:** 1K23HL151901-01A1
- **Recipient organization:** COLUMBIA UNIVERSITY HEALTH SCIENCES
- **Principal Investigator:** David Roh
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $191,154
- **Award type:** 1
- **Project period:** 2021-09-01 → 2026-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10127337

## Citation

> US National Institutes of Health, RePORTER application 10127337, Erythrocyte contribution to coagulopathy and cerebral oxygenation after intracerebral hemorrhage (1K23HL151901-01A1). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10127337. Licensed CC0.

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