Coagulopathy in the Acute Phase of Traumatic Brain Injury

• Published in: Obshchai͡a︡ reanimatologii͡a Vol. 16; no. 1; pp. 27 - 34
• Main Authors: Baranich, A. I., Sychev, A. A., Savin, I. A., Polupan, A. A., Oshorov, A. V., Potapov, A. A.
• Format: Journal Article
• Language: English
• Published: Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology, Moscow, Russia 02-03-2020
• Subjects: hemostasis; tbi-associated coagulopathy; traumatic brain injury
• ISSN: 1813-9779; 2411-7110
• DOI: 10.15360/1813-9779-2020-1-27-34

Acute traumatic brain injury (TBI) can be accompanied by coagulopathy. In TBI, when an increased risk of hemorrhagic lesions in the brain tissue exists, keeping the normal hemostasis is crucial.
The aim
: to determine the incidence of coagulopathy in the acute phase of isolated TBI and identify the correlation between the types of hemostasis disorders and the severity of TBI.
Materials and methods
. We analyzed 323 case records of patients with TBI hospitalized to the Neurosurgery Center ICU from 2008 to 2016, 118 of them were included in the study. Criteria for inclusion were acute isolated TBI, hospitalization in the first 72 hours after injury, young and middle-aged patients. On admission to the hospital, all patients were assessed according to the Glasgow Coma Scale (GCS) and divided into two groups: group I with severe TBI, group 2 with mild and moderate TBI. All patients underwent blood coagulation testing (APTT, PTI, fibrinogen concentration, platelet count).
Results
. In 63.6% of patients with acute TBI coagulopathy were found, most of them (55.1%) had hypocoagulability state and were observed in the group of severe PMT (62.5%). The most frequent signs of coagulopathy were reduced PTI of less than 70% and thrombocytopenia of less than 150×10
9
/l. A weak correlation (
R
=0.276;
P
=0.002) was found between the development of thrombocytopenia and adverse outcomes (1–3 points according to GOS).
Conclusion
. on hospital admission coagulopathy was diagnosed in 63,6% of patients in the acute phase of TBI, hypocoagulability state prevailed. Coagulopathy was significantly more common in patients in the acute phase of severe TBI (GCS8 points).
The mechanisms of TBI-associated coagulopathy have not yet been fully clarified. Further studies of the role of platelet, plasma and fibrinolytic components in the development of coagulopathy are warranted, which require more comprehensive methods of hemostasis investigation.