The Influence of Hemocoagulation Disorders on the Development of Posttraumatic Cerebral Infarction and Outcome in Patients with Moderate or Severe Head Trauma

Abstract

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065–4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090–7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822–28.076), or disseminated intravascular coagulation (DIC) scores (≥5) (OR 4.717, 95% CI 1.778–12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

Impact of a posttraumatic cerebral infarction on outcome in patients with TBI: the Italian multicenter cohort INCEPT study

“…Previous studies were either post-mortem neuropathological investigations or ante-mortem retrospective clinical investigations. Among the latter, the GOS was assessed in four single-center studies at 3 months [5] or 6 months [4,9]; while in one study, the timing of the GOS was not reported [8]. These studies showed increased morbidity [4], increased mortality [9], increased morbidity and mortality [8], or no difference [5] in patients with a PTCI compared with patients without.…”

“…Among the latter, the GOS was assessed in four single-center studies at 3 months [5] or 6 months [4,9]; while in one study, the timing of the GOS was not reported [8]. These studies showed increased morbidity [4], increased mortality [9], increased morbidity and mortality [8], or no difference [5] in patients with a PTCI compared with patients without. In three of these studies [4,5,9], the impact of a PTCI was assessed while considering the role of other predicting variables, such as age and GCS, using multiple regression analysis.…”

“…A PTCI is frequent in patients who die after a moderate or severe TBI, with a reported incidence in post-mortem studies up to 90%. The antemortem occurrence rate of a PTCI has been assessed in six single-center studies, of which only one was prospective, and the rate varied between 1.9% and 20.3% [4][5][6][7][8][9]. None of these studies investigated whether PTCI adds incremental value to current prognostic models.…”

Post-traumatic thrombo-embolic complications in polytrauma patients

“…Nevertheless, we weren't able to identify the individualized risk factors for each factor due to the small number size. Several studies have demonstrated that FVIIa might represent a risk factor in certain patients groups [24], while others weren't able to find evidence in applying fibrinogen concentrate or rFVIIa [25] associated with a higher risk for thrombotic complications.…”

The correlation of D-dimer levels with patient outcomes in acute ischemic cerebrovascular disease complicating coronary heart disease

“…Even so, DIC is not an independent disease, but a pathologic process induced by certain factors on the basis of certain diseases. [44][45][46] Patients suffering from CHD prompted the existent of atherosclerosis, and when they have elevated D-dimer levels, they more likely to have high blood coagulation state. And the happening of AICVD usually associated with plaque rupture and/ or hemodynamic changes.…”