Early thrombocytopenia is associated with an increased risk of mortality in patients with traumatic brain injury treated in the intensive care unit: a Finnish Intensive Care Consortium study

Abstract

Background Coagulopathy after traumatic brain injury (TBI) is associated with poor prognosis. Purpose To assess the prevalence and association with outcomes of early thrombocytopenia in patients with TBI treated in the intensive care unit (ICU). Methods This is a retrospective multicenter study of adult TBI patients admitted to ICUs during 2003–2019. Thrombocytopenia was defined as a platelet count < 100 × 109/L during the first day. The association between thrombocytopenia and hospital and 12-month mortality was tested using multivariable logistic regression, adjusting for markers of injury severity. Results Of 4419 patients, 530 (12%) had early thrombocytopenia. In patients with thrombocytopenia, hospital and 12-month mortality were 26% and 48%, respectively; in patients with a platelet count > 100 × 109/L, they were 9% and 22%, respectively. After adjusting for injury severity, a higher platelet count was associated with decreased odds of hospital mortality (OR 0.998 per unit, 95% CI 0.996–0.999) and 12-month mortality (OR 0.998 per unit, 95% CI 0.997–0.999) in patients with moderate-to-severe TBI. Compared to patients with a normal platelet count, patients with thrombocytopenia not receiving platelet transfusion had an increased risk of 12-month mortality (OR 2.2, 95% CI 1.6–3.0), whereas patients with thrombocytopenia receiving platelet transfusion did not (OR 1.0, 95% CI 0.6–1.7). Conclusion Early thrombocytopenia occurs in approximately one-tenth of patients with TBI treated in the ICU, and it is an independent risk factor for mortality in patients with moderate-to-severe TBI. Further research is necessary to determine whether this is modifiable by platelet transfusion.

A metabolomic and proteomic analysis of pathologic hypercoagulability in traumatic brain injury patients after dura violation

“…This elevation of MA is similar in the numbers reports in previous works of trauma patients that has been linked to increased risk of thrombotic complications (MA, 71.9 mm in patients with thromboses vs. 68.5 mm in patients without thromboses, compared with 74.4 mm post-dura violation vs. 63.5 mm pre-dura violation in our patients), 28 suggesting these changes observed in MA in our data have clinical significance. The increased platelet-mediated clot strength in our patients may be an important player in mitigating the locally hypocoagulopathic environment of hemorrhagic cerebrum, as evidenced by prior reports of higher maximum clot firmness (another viscoelastic metric of clot strength) in TBI survivors versus nonsurvivors 29 and poorer outcomes in TBI patients with thrombocytopenia 30 …”

“…The increased platelet-mediated clot strength in our patients may be an important player in mitigating the locally hypocoagulopathic environment of hemorrhagic cerebrum, as evidenced by prior reports of higher maximum clot firmness (another viscoelastic metric of clot strength) in TBI survivors versus nonsurvivors 29 and poorer outcomes in TBI patients with thrombocytopenia. 30 Beyond the cellular contributions to the pathologic hypercoagulability of TBI, our data highlight an important transition to fibrinolytic shutdown and tPA resistance. There has been controversy in the literature as to whether TBI drives a hyperfibrinolytic or antifibrinolytic phenotype.…”

Association between postoperative thrombocytopenia and outcomes after traumatic brain injury surgery: A cohort study

“…Tsuneoka et al 3 and Engström et al 13 found that TBI caused a decrease in platelets, and thrombocytopenia could predict the short‐term prognosis of these patients. A recent study 24 also suggested that 12% of TBI patients treated in the ICU developed early thrombocytopenia and that thrombocytopenia was associated with an increased risk of mortality in these patients. These studies are consistent with our findings regarding the association between thrombocytopenia and short‐term mortality in patients with TBI.…”

Platelet levels and age are determinants of survival after mild–moderate TBI: A prospective study in Spain

“…In terms of platelet levels, thrombopenia has been reported to increase mortality in TBI ( 31 ), especially in moderate–severe TBI. Thrombopenia facilitates bleeding and the progression of cerebral edema, which leads to an increase in intracranial pressure and a decrease in cerebral perfusion pressure ( 32 ).…”