Jort A. N. van Gent and Thomas A. van Essen contributed equally to this work.
This article is part of the Topical Collection on Brain trauma
Traumatic brain injury aggravated by concomitant coagulopathy is common and associated with increased rates of mortality, morbidity and disability. When coagulopathy is present, rapid reversal should be a high priority to prevent hemorrhage expansion leading to further secondary both intracranial and extracranial trauma consequences. Even though the topic has been discussed in several previous publications, the authors contributed interesting new data that invite further investigations. For instance, antifibrinolytics that have been studied in major trauma to prevent excessive blood loss such as tranexamic acid given early might be promising therapeutic candidates. The authors are congratulated for another valuable contribution to our neurosurgical and neurotraumatological knowledge, despite the study shortcomings, adequately and critically discussed within the manuscript.
Markus F. Oertel
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Traumatic brain injury is associated with high rates of mortality and morbidity. Trauma patients with a coagulopathy have a 10-fold increased mortality risk compared to patients without a coagulopathy. The aim of this study was to identify the incidence of coagulopathy and relate early coagulopathy to clinical outcome in patients with traumatic intracranial hemorrhages.
Between September 2015 and December 2016, 108 consecutive cranial trauma patients with traumatic intracranial hemorrhages were included in this study. To assess the relationship between patients with a coagulopathy and outcome, a chi-squared test was performed.
A total of 29 out of the 108 patients (27%) with a traumatic intracranial hemorrhage developed a coagulopathy within 72 h after admission. Overall, a total of 22 patients (20%) died after admission of which ten were coagulopathic at emergency department presentation. Early coagulopathy in patients with traumatic brain injury is associated with progression of hemorrhagic injury (odds ratio 2.4 (95% confidence interval 0.8–8.0)), surgical intervention (odds ratio 2.8 (95% confidence interval 0.87–9.35)), and increased in-hospital mortality (odds ratio 23.06 (95% confidence interval 5.5–95.9)).
Patients who sustained a traumatic intracranial hemorrhage remained at risk for developing a coagulopathy until 72 h after trauma. Patients who developed a coagulopathy had a worse clinical outcome than patients who did not develop a coagulopathy.
Allard CB, Scarpelini S, Rhind SG, Baker AJ, Shek PN, Tien H, Fernando M, Tremblay L, Morrison LJ, Pinto R, Rizoli SB (2009) Abnormal coagulation tests are associated with progression of traumatic intracranial hemorrhage. J Trauma 67(5):959–967 CrossRef
Bershad EM, Farhadi S, Suri MFK, Feen ES, Hernandez OH, Selman WR, Suarez JI (2008) Coagulopathy and inhospital deaths in patients with acute subdural hematoma. J Neurosurg 109:664–669 CrossRef
Carrick MM, Tyroch AH, Youens CA, Handley T (2005) Subsequent development of thrombocytopenia and coagulopathy in moderate and severe head injury: support for serial laboratory examination. J Trauma 58:725–729 discussion 729-30 CrossRef
Chang R, Cardenas JC, Wade CE, Holcomb JB (2016) Advances in the understanding of trauma-induced coagulopathy. Blood 128:1043–1050 CrossRef
Cohen MJ, Brohi K, Ganter MT, Manley GT, Mackersie RC, Pittet J-F (2007) Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway. J Trauma 63:1254–1261 discussion 1261-1262 CrossRef
Daabiss M (2011) American Society of Anaesthesiologists physical status classification. Indian J Anaesth 55(2):111–115 CrossRef
DeOliveira Manoel AL, Neto AC, Veigas PV, Rizoli S (2015) Traumatic brain injury associated coagulopathy. Neurocrit Care 22:34–44 CrossRef
Epstein DS, Mitra B, O’Reilly G, Rosenfeld JV, Cameron PA (2014) Acute traumatic coagulopathy in the setting of isolated traumatic brain injury: a systematic review and meta-analysis. Injury 45:819–824 CrossRef
Finfer SR, Cohen J (2001) Severe traumatic brain injury. Resuscitation 48:77–90 CrossRef
Folkerson LE, Sloan D, Cotton BA, Holcomb JB, Tomasek JS, Wade CE (2015) Predicting progressive hemorrhagic injury from isolated traumatic brain injury and coagulation. Surgery 158:655–661 CrossRef
Franschman G, Boer C, Andriessen TMJC, van der Naalt J, Horn J, Haitsma I, Jacobs B, Vos PE (2012) Multicenter evaluation of the course of coagulopathy in patients with isolated traumatic brain injury: relation to CT characteristics and outcome. J Neurotrauma 29:128–136 CrossRef
Ghajar J (2000) Traumatic brain injury. Lancet 356:923–929 CrossRef
Giesen PLA, Nemerson Y (2000) Tissue factor on the loose. Semin Thromb Hemost 26:379–384 CrossRef
Giesen PLA, Rauch U, Bohrmann B, Kling D, Roqué M, Fallon JT, Badimon JJ, Himber J, Riederer MA, Nemerson Y (1999) Blood-borne tissue factor: another view of thrombosis. Proc Natl Acad Sci 96:2311–2315 CrossRef
Greuters S, Van Den Berg A, Franschman G, Viersen VA, Beishuizen A, Peerdeman SM, Boer C, ALARM-BLEEDING investigators (2011) Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury. Crit Care 15:R2 CrossRef
Halpern CH, Reilly PM, Turtz AR, Stein SC (2008) Traumatic coagulopathy: the effect of brain injury. J Neurotrauma 25:997–1001 CrossRef
Harhangi BS, Kompanje EJO, Leebeek FWG, Maas a IR (2008) Coagulation disorders after traumatic brain injury. Acta Neurochir 150:165–175 discussion 175 CrossRef
Juratli TA, Zang B, Litz RJ, Sitoci K-H, Aschenbrenner U, Gottschlich B, Daubner D, Schackert G, Sobottka SB (2014) Early hemorrhagic progression of traumatic brain contusions: frequency, correlation with coagulation disorders, and patient outcome: a prospective study. J Neurotrauma 31:1521–1527 CrossRef
Kaups KL, Davis JW, Parks SN (2004) Routinely repeated computed tomography after blunt head trauma: does it benefit patients? J Trauma 56:475–480 discussion 480-1 CrossRef
Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM (2012) Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma 29:19–31 CrossRef
Laroche M, Kutcher ME, Huang MC, Cohen MJ, Manley GT (2012) Coagulopathy after traumatic brain injury. Neurosurgery 70:1334–1345 CrossRef
Lustenberger T, Talving P, Kobayashi L, Barmparas G, Inaba K, Lam L, Branco BC, Demetriades D (2010) Early coagulopathy after isolated severe traumatic brain injury: relationship with hypoperfusion challenged. J Trauma 69:1410–1414 CrossRef
Maas AIR, Stocchetti N, Bullock R (2008) Moderate and severe traumatic brain injury in adults. Lancet Neurol 7:728–741 CrossRef
Maas AIR, Menon DK, Steyerberg EW, CENTER-TBI investigators (2015) Collaborative European neurotrauma effectiveness research in traumatic brain injury (CENTER-TBI): A prospective longitudinal observational study. Neurosurgery 76:67–80 CrossRef
Maegele M (2013) Coagulopathy after traumatic brain injury: Incidence, pathogenesis, and treatment options. Transfusion. 53:28S–37S CrossRef
Oertel M, Kelly DF, McArthur D, Boscardin WJ, Glenn TC, Lee JH, Gravori T, Obukhov D, McBride DQ, Martin NA (2002) Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg 96:109–116 CrossRef
Rezaie AR (2001) Vitronectin functions as a cofactor for rapid inhibition of activated protein C by plasminogen activator inhibitor-1: implications for the mechanism of profibrinolytic action of activated protein C. J Biol Chem 276:15567–15570 CrossRef
Roozenbeek B, Maas AIR, Menon DK (2013) Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol 9:231–236 CrossRef
Stein SC, Spettell C, Young G, Ross SE (1993) Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 32:25–30 discussion 30-1 CrossRef
Stein DM, Dutton RP, Kramer ME, Scalea TM (2009) Reversal of coagulopathy in critically ill patients with traumatic brain injury: recombinant factor VIIa is more cost-effective than plasma. J Trauma 66:63–72 discussion 73-75 CrossRef
Talving P, Lustenberger T, Lam L, Inaba K, Mohseni S, Plurad D, Green DJ, Demetriades D (2011) Coagulopathy after isolated severe traumatic brain injury in children. J Trauma 71:1205–1210 CrossRef
Wafaisade A, Lefering R, Tjardes T, Wutzler S, Simanski C, Paffrath T, Fischer P, Bouillon B, Maegele M (2010) Acute coagulopathy in isolated blunt traumatic brain injury. Neurocrit Care 12:211–219 CrossRef
- Coagulopathy after hemorrhagic traumatic brain injury, an observational study of the incidence and prognosis
Jort A. N. van Gent
Thomas A. van Essen
Mettine H. A. Bos
Suzanne C. Cannegieter
Jeroen T. J. M. van Dijck
Wilco C. Peul
- Springer Vienna
Neu im Fachgebiet Chirurgie
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