Article (Scientific journals)
Extended Coagulation Profiling in Isolated Traumatic Brain Injury: A CENTER-TBI Analysis.
Böhm, Julia K; Schaeben, Victoria; Schäfer, Nadine et al.
2021In Neurocritical Care
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Keywords :
CENTER-TBI; Coagulopathy; Fibrin monomers; Progressive intracranial hemorrhage; Thrombin generation; Traumatic brain injury
Abstract :
[en] BACKGROUND: Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. METHODS: Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) (n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR < 1.2 and (2) INR ≥ 1.2. An INR > 1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick's value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers. RESULTS: Patients with iTBI with INR ≥ 1.2 (n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR < 1.2 (n = 72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15-20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as reflected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fibrin monomers increased. Plasminogen activity significantly decreased from 89% in patients with INR < 1.2 to 76% in patients with INR ≥ 1.2. Moreover, D-dimer levels significantly increased from a mean of 943 mg/L in patients with INR < 1.2 to 1,301 mg/L in patients with INR ≥ 1.2. CONCLUSIONS: This more in-depth analysis beyond routine conventional coagulation assays suggests a counterbalanced regulation of coagulation and fibrinolysis in patients with iTBI with hemostatic abnormalities. We observed distinct patterns involving key pathways of the highly complex and dynamic coagulation system that offer windows of opportunity for further research. Whether the changes observed on factor levels may be relevant and explain the worse outcome or the more severe brain injuries by themselves remains speculative.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
Böhm, Julia K;  Institute for Research in Operative Medicine, Faculty of Health, Department of
Schaeben, Victoria;  Institute for Research in Operative Medicine, Faculty of Health, Department of
Schäfer, Nadine;  Institute for Research in Operative Medicine, Faculty of Health, Department of
Güting, Helge;  Institute for Research in Operative Medicine, Faculty of Health, Department of
Lefering, Rolf;  Institute for Research in Operative Medicine, Faculty of Health, Department of
Thorn, Sophie;  Emergency and Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, VIC,
Schöchl, Herbert;  Department of Anesthesiology and Intensive Care, AUVA Trauma Hospital, Academic  ; Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma
Zipperle, Johannes;  Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma
Grottke, Oliver;  Department of Anesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30,
Rossaint, Rolf;  Department of Anesthesiology, RWTH Aachen University Hospital, Pauwelsstraße 30,
Stanworth, Simon;  NHS Blood and Transplant, John Radcliffe Hospital, Oxford University Hospital NHS
Curry, Nicola;  Oxford Haemophilia and Thrombosis Centre, Churchill Hospital, Oxford University
Maegele, Marc;  Institute for Research in Operative Medicine, Faculty of Health, Department of  ; Department of Traumatology, Orthopedic Surgery and Sports Traumatology,
CENTER-TBI Participants and, Investigators
More authors (4 more) Less
Other collaborator :
Åkerlund, Cecilia
Amrein, Krisztina
Andelic, Nada
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Audibert, Gérard
Azouvi, Philippe
Azzolini, Maria Luisa
Bartels, Ronald
Barzó, Pál
Beauvais, Romuald
Beer, Ronny
Bellander, Bo-Michael
Belli, Antonio
Benali, Habib
Berardino, Maurizio
Beretta, Luigi
Blaabjerg, Morten
Bragge, Peter
Brazinova, Alexandra
Brinck, Vibeke
Brooker, Joanne
Brorsson, Camilla
Buki, Andras
Bullinger, Monika
Cabeleira, Manuel
Caccioppola, Alessio
Calappi, Emiliana
Calvi, Maria Rosa
Cameron, Peter
Lozano, Guillermo Carbayo
Carbonara, Marco
Cavallo, Simona
Chevallard, Giorgio
Chieregato, Arturo
Citerio, Giuseppe
Ceyisakar, Iris
Clusmann, Hans
Coburn, Mark
Coles, Jonathan
Cooper, Jamie D
Correia, Marta
Čović, Amra
Curry, Nicola
Czeiter, Endre
Czosnyka, Marek
Dahyot-Fizelier, Claire
Dark, Paul
Dawes, Helen
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Degos, Vincent
Corte, Francesco Della
Boogert, Hugo den
Depreitere, Bart
Đilvesi, Đula
Dixit, Abhishek
Donoghue, Emma
Dreier, Jens
Dulière, Guy-Loup
Ercole, Ari
Esser, Patrick
Ezer, Erzsébet
Fabricius, Martin
Feigin, Valery L
Foks, Kelly
Frisvold, Shirin
Furmanov, Alex
Gagliardo, Pablo
Galanaud, Damien
Gantner, Dashiell
Gao, Guoyi
George, Pradeep
GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
Giga, Lelde
Glocker, Ben
Golubovic, Jagoš
Gomez, Pedro A
Gratz, Johannes
Gravesteijn, Benjamin
Grossi, Francesca
Gruen, Russell L
Gupta, Deepak
Haagsma, Juanita A
Haitsma, Iain
Helbok, Raimund
Helseth, Eirik
Horton, Lindsay
Huijben, Jilske
Hutchinson, Peter J
Jacobs, Bram
Jankowski, Stefan
Jarrett, Mike
Jiang, Ji-Yao
Johnson, Faye
Jones, Kelly
Karan, Mladen
Kolias, Angelos G
Kompanje, Erwin
Kondziella, Daniel
Koraropoulos, Evgenios
Koskinen, Lars-Owe
Kovács, Noémi
Kowark, Ana
Lagares, Alfonso
Lanyon, Linda
LAUREYS, Steven  ;  Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
Lecky, Fiona
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Lefering, Rolf
Legrand, Valerie
Lejeune, Aurelie
Levi, Leon
Lightfoot, Roger
Lingsma, Hester
Maas, Andrew I R
Castaño-León, Ana M
Maegele, Marc
Majdan, Marek
Manara, Alex
Manley, Geoffrey
Martino, Costanza
Maréchal, Hugues
Mattern, Julia
McMahon, Catherine
Melegh, Béla
Menon, David
Menovsky, Tomas
Mikolic, Ana
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Muraleedharan, Visakh
Murray, Lynnette
Negru, Ancuta
Nelson, David
Newcombe, Virginia
Nieboer, Daan
Nyirádi, József
Olubukola, Otesile
Oresic, Matej
Ortolano, Fabrizio
Palotie, Aarno
Parizel, Paul M
Payen, Jean-François
Perera, Natascha
Perlbarg, Vincent
Persona, Paolo
Peul, Wilco
Piippo-Karjalainen, Anna
Pirinen, Matti
Ples, Horia
Polinder, Suzanne
Pomposo, Inigo
Posti, Jussi P
Puybasset, Louis
Radoi, Andreea
Ragauskas, Arminas
Raj, Rahul
Rambadagalla, Malinka
Rhodes, Jonathan
Richardson, Sylvia
Richter, Sophie
Ripatti, Samuli
Rocka, Saulius
Roe, Cecilie
Roise, Olav
Rosand, Jonathan
Rosenfeld, Jeffrey V
Rosenlund, Christina
Rosenthal, Guy
Rossaint, Rolf
Rossi, Sandra
Rueckert, Daniel
Rusnák, Martin
Sahuquillo, Juan
Sakowitz, Oliver
Sanchez-Porras, Renan
Sandor, Janos
Schäfer, Nadine
Schmidt, Silke
Schoechl, Herbert
Schoonman, Guus
Schou, Rico Frederik
Schwendenwein, Elisabeth
Sewalt, Charlie
Skandsen, Toril
Smielewski, Peter
Sorinola, Abayomi
Stamatakis, Emmanuel
Stanworth, Simon
Stevens, Robert
Stewart, William
Steyerberg, Ewout W
Stocchetti, Nino
Sundström, Nina
Synnot, Anneliese
Takala, Riikka
Tamás, Viktória
Tamosuitis, Tomas
Taylor, Mark Steven
Ao, Braden Te
Tenovuo, Olli
Theadom, Alice
Thomas, Matt
Tibboel, Dick
Timmers, Marjolein
Tolias, Christos
Trapani, Tony
Tudora, Cristina Maria
Unterberg, Andreas
Vajkoczy, Peter
Vallance, Shirley
Valeinis, Egils
Vámos, Zoltán
van der Jagt, Mathieu
Van der Steen, Gregory
Naalt, Joukje van der
van Dijck, Jeroen T J M
van Essen, Thomas A
Van Hecke, Wim
van Heugten, Caroline
Van Praag, Dominique
Vyvere, Thijs Vande
van Wijk, Roel P J
Vargiolu, Alessia
Vega, Emmanuel
Velt, Kimberley
Verheyden, Jan
Vespa, Paul M
Vik, Anne
Vilcinis, Rimantas
Volovici, Victor
von Steinbüchel, Nicole
Voormolen, Daphne
Vulekovic, Petar
Wang, Kevin K W
Wiegers, Eveline
Williams, Guy
Wilson, Lindsay
Winzeck, Stefan
Wolf, Stefan
Yang, Zhihui
Ylén, Peter
Younsi, Alexander
Zeiler, Frederick A
Zelinkova, Veronika
Ziverte, Agate
Zoerle, Tommaso
More authors (237 more) Less
Language :
English
Title :
Extended Coagulation Profiling in Isolated Traumatic Brain Injury: A CENTER-TBI Analysis.
Publication date :
16 December 2021
Journal title :
Neurocritical Care
ISSN :
1541-6933
eISSN :
1556-0961
Publisher :
Humana Press, Us
Peer reviewed :
Peer Reviewed verified by ORBi
Funding number :
602150/FP7 European 7th Framework Programme (FP7/2007-2013)/; 2014014/ZNS - Hannelore Kohl Stiftung/
Commentary :
© 2021. The Author(s).
Available on ORBi :
since 27 March 2022

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