Coagulopathy as a predictor of mortality after penetrating traumatic brain injury

Folkerson, Lindley E.; Sloan, Duncan; Davis, Elizabeth; Kitagawa, Ryan S.; Cotton, Bryan A.; Holcomb, John B.; Tomasek, Jeffrey S.; Wade, Charles E.

doi:10.1016/j.ajem.2017.06.057

Cited by 43 publications

(38 citation statements)

References 28 publications

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“…1,2 Coagulopathy associated with extracranial injuries is primarily caused by substantial blood loss (hemorrhagic shock), consumption, hypothermia, and hypoperfusion-induced metabolic acidosis, and it can be further propagated by iatrogenic factors such as fluid resuscitation (hemodilution). 3,4 Retrospective and observational studies have consistently shown that coagulopathy is equally prevalent in patients with isolated traumatic brain injury (TBI), [5][6][7] which is increasingly common because falls have surpassed automobile incidents as the leading cause of TBI in civilians. 8 A demographic shift in TBI patients from being predominantly young to increasingly older ($50 years) is attributed to this change.…”

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confidence: 99%

Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury

Zhang

Dong

2018

Blood

115

102

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Traumatic brain injury (TBI)-induced coagulopathy is a common and well-recognized risk for poor clinical outcomes, but its pathogenesis remains poorly understood, and treatment options are limited and ineffective. We discuss the recent progress and knowledge gaps in understanding this lethal complication of TBI. We focus on (1) the disruption of the brain-blood barrier to disseminate brain injury systemically by releasing brain-derived molecules into the circulation and (2) TBI-induced hypercoagulable and hyperfibrinolytic states that result in persistent and delayed intracranial hemorrhage and systemic bleeding.

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confidence: 99%

Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury

Zhang

Dong

2018

Blood

115

102

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“…Retrospective and observational studies have consistently shown that coagulopathy is also common in patients with isolated TBI, which is increasingly common among civilians . A post‐hoc outcomes analysis of 670 patients with isolated TBI or with TBI plus hemorrhagic shock enrolled in the Pragmatic Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial found that patients with both TBI and hemorrhagic shock had worse coagulopathy than patients with either condition alone before resuscitation, significantly greater odds of respiratory complications, and a higher mortality rate .…”

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confidence: 99%

“…The causation of trauma-induced coagulopathy is multifactorial, including blood loss, consumption or dilution of coagulation factors and platelets, dysfunctions of platelets and the coagulation system, enhanced fibrinolysis, hypothermia, and metabolic acidosis secondary to tissue ischemia. [3][4][5][6] Retrospective and observational studies have consistently shown that coagulopathy is also common in patients with isolated TBI, [7][8][9] which is increasingly common among civilians. 10 A post-hoc outcomes analysis of 670 patients with isolated TBI or with TBI plus hemorrhagic shock enrolled in the Pragmatic Randomized Optimal Platelets and Plasma Ratios (PROPPR) trial 11 found that patients with both TBI and hemorrhagic shock had worse coagulopathy than patients with either condition alone before resuscitation, significantly greater odds of respiratory complications, and a higher mortality rate.…”

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confidence: 99%

Current state of transfusion in traumatic brain injury and associated coagulopathy

et al. 2019

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Traumatic brain injury (TBI)‐induced coagulopathy has long been recognized as a significant risk for poor outcomes in patients with TBI, but its pathogenesis remains poorly understood. As a result, current treatment options for the condition are limited and ineffective. The lack of information is most significant for the impact of blood transfusions on patients with isolated TBI and in the absence of confounding influences from trauma to the body and limbs and the resultant hemorrhagic shock. Here we discuss recent progress in understanding the pathogenesis of TBI‐induced coagulopathy and the current state of blood transfusions for patients with TBI and associated coagulopathy.

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“…Post-hoc analysis also revealed that TBI patients with concomitant hemorrhagic shock had worse pre-resuscitation coagulopathy than all other groups, signifying that understanding and implementing balanced damage control resuscitation is crucial for any provider caring for TBI patients [24]. Furthermore, the presence of coagulopathy has been demonstrated to lead to worsened outcomes in penetrating TBI [101].…”

Section: Blood Productsmentioning

confidence: 97%

Resuscitation Strategies for Traumatic Brain Injury

Caplan

Cox

2019

Curr Surg Rep

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Purpose of Review: Traumatic brain injury (TBI) is a leading cause of morbidity and mortality; however, little definitive evidence exists about most clinical management strategies. Here, we highlight important differences between two major guidelines, the 2016 Brain Trauma Foundation guidelines and the Lund Concept, along with recent pre-clinical and clinical data. Recent findings: While intracranial pressure (ICP) monitoring has been questioned, the majority of literature demonstrates benefit in severe TBI. The optimal cerebral perfusion pressure (CPP) and ICP are yet unknown, but likely as important is the concept of ICP burden. The evidence for anti-hypertensive therapy is strengthening. Decompressive craniectomy improves mortality, but at the cost of increased morbidity. Plasma-based resuscitation has demonstrated benefit in multiple pre-clinical TBI studies. Summary: The management of hemodynamics and intravascular volume are crucial in TBI. Based on recent evidence, ICP monitoring, anti-hypertensive therapy, minimal use of vasopressors/inotropes, and plasma resuscitation may improve outcomes.

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Coagulopathy as a predictor of mortality after penetrating traumatic brain injury

Cited by 43 publications

References 28 publications

Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury

Coagulopathy induced by traumatic brain injury: systemic manifestation of a localized injury

Current state of transfusion in traumatic brain injury and associated coagulopathy

Resuscitation Strategies for Traumatic Brain Injury

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