Coagulopathy in Severe Traumatic Brain Injury: A Prospective Study

Abstract

The incidence of TBI coagulopathy in SHI is high, especially in penetrating injuries. Independent risk factors for coagulopathy in isolated head injuries include GCS score of <or=8, ISS >or=16, hypotension upon admission, cerebral edema, subarachnoid hemorrhage, and midline shift. The development of TBI coagulopathy is associated with longer ICU length of stay and an almost 10-fold increased risk of death.

Hypocoagulability in Traumatic Brain Injury as Measured by Traditional Means and Thrombelastography

“…Abnormalities in admission PT, aPTT, INR, and fibrinogen degradation products have all been linked to increased morbidity and mortality in TBI patients [3,4,7,12,27,28,[32][33][34][35][36][37]. However, when we analyzed admission CCT values on 1924 of our highest-level trauma activations over 18 months, no statistically significant difference in the prevalence of coagulopathy based on these values was detected in TBI patients compared to non-TBI patients (Table 2).…”

“…Coagulopathy frequently accompanies severe TBI and compounds the risk of morbidity and mortality [3][4][5][6][7][8][9]. However, the incidence and factors associated with coagulopathy in TBI has not been firmly established [4,7,[10][11][12].…”

“…In 2009, Talving et al published the only prospective data to date from a level I urban trauma center, demonstrating a 34-36% incidence of coagulopathy in TBI patients, as measured by International Normalized Ration (INR), activated partial thromboplastin time (aPTT), and platelet count. In this study, independently associated risk factors for coagulopathy among isolated TBI patients included a GCS ≤ 8, an ISS ≥ 16, the presence of cerebral edema, subarachnoid hemorrhage, or a midline shift upon admission [4].…”

Coagulation disorder in moderate to severe traumatic brain injuries

“…Affonseca 11 also included moderate to severe head injuries in his study which consisted of 37.2% patients with moderated traumatic brain injury and 62.8% severe traumatic brain injury and, similar to our fi ndings, he had shown association of coagulopathy with GCS of the patient. Talving 10 , in his study of 436 patients with traumatic traumatic brain injury, has shown statistically signifi cant association of development of coagulopathy with GCS of the patient.…”

Anesthetic considerations in organ procurement surgery: a narrative review

“…63 Coagulopathy can occur in isolated head injury, and the development of coagulopathy after brain injury is associated with a worse outcome. 64 The release of tissue factor from injured cortical parenchyma may contribute to, or even be responsible for, the development of coagulopathy and, when severe, subsequent disseminated intravascular coagulation.…”