Implementation of Thromboelastometry for Coagulation Management in Isolated Traumatic Brain Injury Patients Undergoing Craniotomy

Rimaitis, Marius; Bilskienė, Diana; Tamošuitis, Tomas; Vilcinis, Rimantas; Rimaitis, Kęstutis; Macas, Andrius

doi:10.12659/msm.922879

Cited by 16 publications

(42 citation statements)

References 26 publications

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“…The use of anticoagulant monitoring parameters (e.g., viscoelastic test, international normalized ratio) in TBI is becoming more important in clinical practice, and targeted coagulant therapy might be a new way to improve the outcome of TBI [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Is the Regular Intake of Anticoagulative Agents an Independent Risk Factor for the Severity of Traumatic Brain Injuries in Geriatric Patients? A Retrospective Analysis of 10,559 Patients from the TraumaRegister DGU®

et al. 2020

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The purpose of this study was to assess anticoagulant medication as an independent factor influencing the occurrence of a severe traumatic brain injury in geriatric patients. Data were collected from the TraumaRegister DGU® between January 2015 and December 2018. We included patients with an age of ≥65 years with a blunt TBI; an AISHead ≥2 but no other relevant injuries. Patients were divided into five subgroups: no anticoagulant medication, anti-platelet drugs, vitamin K antagonists, direct-oral-anticoagulants, and heparinoids. Separation between moderate TBI (AISHead 2–3) and severe TBI (AISHead ≥ 4) and multivariable regression analysis were performed. The average age of 10,559 included patients was 78.8 years with a mean ISS of 16.8 points and a mortality of 22.9%. The most common cause of injury was a low fall of <3 m with 72.8%. With increasing age, the number of patients without any anticoagulant therapy decreased from 65.9% to 29.9%. The intake of coagulation medication increased mortality significantly. Severe TBI was observed in 51% of patients without medication and ranged from 61 to 67% with anticoagulant drugs. After adjusting for confounding variables, the intake of VKA or DOACs was significantly associated with an increased risk of severe TBI. The use of anticoagulant medication is an independent factor and is associated with an increased severity of TBI depending on the type of medication used.

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Section: Discussionmentioning

confidence: 99%

Is the Regular Intake of Anticoagulative Agents an Independent Risk Factor for the Severity of Traumatic Brain Injuries in Geriatric Patients? A Retrospective Analysis of 10,559 Patients from the TraumaRegister DGU®

et al. 2020

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“…25 One study involved a wide range of emergent neurosurgical procedures ranging from craniotomies to hematoma evacuation. 26 Four studies (Li, 22 Ellenberger, 24 Vahtera 20 and Rimaitis 23 ) used either TEG or ROTEM. Von der Brelie et al 21 utilized the PFA-100®.…”

Section: Characteristics and Quality Of Studiesmentioning

confidence: 99%

Point of Care Platelet Function Testing for Guided Transfusion in Neurosurgical Management of Intracranial Hemorrhage: A Systematic Review

Lim

Sim

et al. 2022

Preprint

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Given the rising prevalence of antiplatelet therapy, rapid preoperative identification of patients with bleeding diathesis is necessary for the guidance of blood product administration. This is especially relevant in neurosurgery for intracranial hemorrhage (ICH), where indiscriminate transfusions may lead to further hemorrhagic or thromboembolic injury. Point-of-care (POC) testing of platelet function is a promising solution to this dilemma, as it has been proven effective in cardiac surgery. However, to date, POC platelet function testing in neurosurgery has not been extensively evaluated. This systematic review appraises the use of POC platelet function test (PFT) in emergency neurosurgery in terms of its impact on patient outcomes. A comprehensive search was conducted on four electronic databases (Pubmed, MEDLINE, Embase, and Cochrane) for relevant English language articles from their respective inceptions until 1 June 2022. We included all randomized controlled trials and cohort studies that met the following inclusion criteria: (i) involved adult patients undergoing neurosurgery for ICH; (ii) evaluated platelet function via POC PFT; (iii) reported a change in perioperative blood loss; and/or (iv) reported data on treatment-related adverse events and mortality. Assessment of study quality was conducted using the Newcastle Ottawa Quality Assessment Scale for Cohort Studies and Case-Control Studies, and the JBI Critical Appraisal Checklist for Case Series. The search yielded 2,835 studies, of which seven observational studies comprising 849 patients met the inclusion criteria for this review. Overall, there is evidence that the use of POC PFT to assess bleeding risk reduced bleeding events, thromboembolic adverse outcomes, and the length of hospitalization. However, there is currently insufficient evidence to suggest that using POC PFT improves blood product use, functional outcomes or mortality.

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“…In addition to its fluctuant frequency, CTBI is defined by variable cut-off values when using common coagulation assays (CCAs), such as platelet count, prothrombin time (PT), international normalized ratio (INR), partial thromboplastin time (PTT), and fibrinogen levels. CCAs are also limited to detecting the initiation of clot formation and fail to provide information regarding the strength and integrity of the clot formed [4,6,23,[42][43][44][45][46][47][48]. Furthermore, CCAs are not sensitive detectors of hemostatic integrity in patients with multiple systemic polytrauma, including TBI, and fail to predict coagulopathy in patients on pre-injury anticoagulant medications, particularly antiplatelet drugs.…”

Section: Implications Of Ctbi and Relation To Vet-based Definitionmentioning

confidence: 99%

“…In both isolated TBI and polytrauma TBI patients, VET assays provide real-time assessment of hemostasis and prognostication [6,[44][45][46][47]60,75,76]. Compared to CCAs, the rapidity at which "global" hemostatic assays predict outcome and severity in a population of patients with severe TBI is significant [6,77].…”

Section: Inadequacy Of Conventional Coagulation Assays In the Diagnosis Of Ctbimentioning

confidence: 99%

“…In addition, the iTACTIC study indicated possible improvement and survival in the subgroup of injured multiple trauma patients with TBI whose resuscitation was guided by ROTEM ® with specific emphasis on FIBTEM-guided resuscitation using soluble fibrinogen concentrate [140]. Improved clot quality with decreased neurosurgi-cal reintervention and decreased incidence of progressive hemorrhagic injury PHI has been noted with ROTEM ® [45]. Delayed clot formation without associated fibrinolytic abnormalities is a singular manifestation of the unique hemostatic derangement of severe isolated TBI.…”

Section: Treatment Of Ctbimentioning

confidence: 99%

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Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

Bradbury

Thomas

Sorg

et al. 2021

JCM

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A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.

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Implementation of Thromboelastometry for Coagulation Management in Isolated Traumatic Brain Injury Patients Undergoing Craniotomy

Cited by 16 publications

References 26 publications

Is the Regular Intake of Anticoagulative Agents an Independent Risk Factor for the Severity of Traumatic Brain Injuries in Geriatric Patients? A Retrospective Analysis of 10,559 Patients from the TraumaRegister DGU®

Is the Regular Intake of Anticoagulative Agents an Independent Risk Factor for the Severity of Traumatic Brain Injuries in Geriatric Patients? A Retrospective Analysis of 10,559 Patients from the TraumaRegister DGU®

Point of Care Platelet Function Testing for Guided Transfusion in Neurosurgical Management of Intracranial Hemorrhage: A Systematic Review

Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury

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