Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A  CENTER-TBI Analysis.

Blood Coagulation Disorders/epidemiology/etiology; Blood Coagulation Tests; Brain Injuries, Traumatic/complications; Glasgow Coma Scale; Humans; Prospective Studies; CENTER-TBI; Coagulopathy; Risk factors; Traumatic brain injury

Abstract :

[en] BACKGROUND: Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. METHODS: This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. RESULTS: Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to - 6, hypothermia and hypotension increased risk significantly. CONCLUSION: Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.

Disciplines :

Human health sciences: Multidisciplinary, general & others

Author, co-author :

Böhm, Julia K; Department of Medicine, Faculty of Health, Institute for Research in Operative

Güting, Helge; Department of Medicine, Faculty of Health, Institute for Research in Operative

Thorn, Sophie; Emergency and Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC,

Schäfer, Nadine; Department of Medicine, Faculty of Health, Institute for Research in Operative

Rambach, Victoria; Department of Medicine, Faculty of Health, Institute for Research in Operative

Schöchl, Herbert; Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Academic ; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Research

Grottke, Oliver; Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30,

Rossaint, Rolf; Department of Anaesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30,

Stanworth, Simon; NHS Blood and Transplant, Oxford University Hospital NHS Foundation Trust, Headley

Curry, Nicola; NHS Blood and Transplant, Oxford University Hospital NHS Foundation Trust, Headley

More authors (3 more)

Other collaborator :

Åkerlund, Cecilia

Amrein, Krisztina

Andelic, Nada

Andreassen, Lasse

Anke, Audny

Antoni, Anna

Audibert, Gérard

Azouvi, Philippe

Azzolini, Maria Luisa

Bartels, Ronald

More authors (237 more)

Language :

English

Title :

Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis.

Publication date :

August 2021

Journal title :

Neurocritical Care

ISSN :

1541-6933

eISSN :

1556-0961

Publisher :

Humana Press, Us

Volume :

Issue :

Pages :

184-196

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 27 March 2022

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