Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury

Abstract

IntroductionThe relationship between isolated traumatic brain injury (TBI) associated coagulopathy and patient prognosis frequently lacks information regarding the time course of coagulation disorders throughout the post-traumatic period. This study was conducted to assess the prevalence and time course of post-traumatic coagulopathy in patients with isolated TBI and the relationship of these hemostatic disorders with outcome.MethodsThe local Human Subjects Committee approved the study. We retrospectively studied the medical records of computed tomography (CT)-confirmed isolated TBI patients with an extracranial abbreviated injury scale (AIS) <3 who were primarily referred to a Level 1 trauma centre in Amsterdam (n = 107). Hemostatic parameters including activated partial thromboplastin time (aPTT), prothrombin time (PT), platelet count, hemoglobin, hematocrit, glucose, pH and lactate levels were recorded throughout a 72-hour period as part of a routine standardized follow-up of TBI. Coagulopathy was defined as a aPPT >40 seconds and/or a PTT in International Normalized Ratio (INR) >1.2 and/or a platelet count <120*109/l.ResultsPatients were mostly male, aged 48 ± 20 years with a median injury severity score of 25 (range 20 to 25). Early coagulopathy as diagnosed in the emergency department (ED) occurred in 24% of all patients. The occurrence of TBI-related coagulopathy increased to 54% in the first 24 hours post-trauma. In addition to an increased age and disturbed pupillary reflex, both coagulopathy upon ED arrival and during the first 24 hours post-trauma provided an independent prognostic factor for unfavorable outcome (odds ratio (OR) 3.75 (95% CI 1.07 to 12.51; P = 0.04) and OR 11.61 (2.79 to 48.34); P = 0.003).ConclusionsOur study confirms a high prevalence of early and delayed coagulopathy in patients with isolated TBI, which is strongly associated with an unfavorable outcome. These data support close monitoring of hemostasis after TBI and indicate that correction of coagulation disturbances might need to be considered.

Multicenter Evaluation of the Course of Coagulopathy in Patients with Isolated Traumatic Brain Injury: Relation to CT Characteristics and Outcome

“…This prospective, multicenter study showed that a large proportion of patients with isolated TBI developed hemostatic disturbances, and confirmed an estimated incidence rate of TBI-related early coagulopathy of 20-35%, as reported by others (Greuters et al, 2011;Harhangi et al, 2008;Wafaisade et al, 2010). In addition, an equal proportion of patients developed late-onset coagulopathy within the first 48 h after trauma.…”

“…Although we and others show that the occurrence of coagulopathy in the first 48 h after trauma is independently and strongly associated with unfavorable outcome in TBI (Carrick et al, 2005;Greuters et al, 2011;Harhangi et al, 2008;Wafaisade et al, 2010;Zehtabchi et al, 2008;), it is not identified as an independent risk factor for survival (Chesnut et al, 2000;Perel et al, 2008;Steyerberg et al, 2008). Our study further provides additional information with respect to the course of coagulopathy and its relation to initial CT findings in these patients.…”

The prognostic value of plasma nesfatin-1 concentrations in patients with traumatic brain injury

“…Coagulation test or blood routine test were completed using the routine laboratory assay. ATC was defined as an activated partial thromboplastic time N 40 s and/or international normalized ratio N 1.2 and/or a platelet count b 120 × 10 9 /l [24,25]. Blood samples for nesfatin-1 assessment were placed on ice, centrifuged at 3000 ×g, and plasma aliquoted and frozen at −70°C.…”

Review of Thromboelastography in Neurocritical Care

“…Data have repeatedly demonstrated that patients with coagulopathy following TBI have worse outcomes [22]. In 2007, the IMPACT study identified prolongation of PT on admission to be an independent risk factor of poor outcome following TBI [23].…”