Coagulopathy in Isolated Traumatic Brain Injury: Myth or Reality

Introduction Traumatic Brain Injury (TBI) has been shown to be associated with altered hemostasis and coagulopathy, that correlates with worsening secondary injury and clinical outcomes. Isolated Traumatic Brain Injury (iTBI), that is TBI without significant extracranial injuries, has also been show...

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Vydáno v:Neurocritical care Ročník 38; číslo 2; s. 429 - 438
Hlavní autoři: Mathur, Rohan, Suarez, Jose I.
Médium: Journal Article
Jazyk:angličtina
Vydáno: New York Springer US 01.04.2023
Springer Nature B.V
Témata:
Adenosine
Anticoagulants
Blood Coagulation Disorders
Blood platelets
Brain Injuries, Traumatic - complications
Brain research
Cohort analysis
Connective tissue
Critical Care Medicine
Endothelium
Enzymes
Extracranial Complications after Traumatic Brain Injury
Head injuries
Humans
Intensive
Internal Medicine
Medicine
Medicine & Public Health
Neurology
Neurosurgery
Observational studies
Proteins
Trauma
Traumatic brain injury
Primary brain injury
Secondary brain injury
Traumatic brain injury
Coagulopathy
Outcomes
ISSN:1541-6933, 1556-0961, 1556-0961
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Shrnutí:Introduction Traumatic Brain Injury (TBI) has been shown to be associated with altered hemostasis and coagulopathy, that correlates with worsening secondary injury and clinical outcomes. Isolated Traumatic Brain Injury (iTBI), that is TBI without significant extracranial injuries, has also been shown to be associated with systemic coagulopathy and derangements in hemostasis. Methods Literature Review. Results Present your results in logical sequence in the text, tables, and figures, giving the main or most important findings first. Do not repeat all the data in the tables or figures in the text; emphasize or summarize only the most important observations. Provide data on all primary and secondary outcomes identified in the Methods section. Give numeric results not only as derivatives (e.g. percentages) but also as the absolute numbers from which the derivatives were calculated, and specify the statistical significance attached to them, if any. Discussion In this review, we provide an overview of the pathophysiology of the hemostatic disturbances caused by iTBI, review key clinical findings and discrepancies in the way this question has been approached, describe the use and role of global viscoelastic assays such as the thromboelastrogram, and detail principles for reversal of pre-injury blood thinners. Conclusions iTBI is clearly associated with the development of coagulopathy, but the extent to which it occurs is confounded by the fact that many of the studies have included patients with moderate extracranial trauma into the iTBI category. The coagulopathy itself has been better studied in preclinical models, and the mechanisms driving it suggest a pattern consistent with disseminated intravascular coagulation with hyperfibrinolysis. We provide pragmatic clinical takeaways and suggestions for future research.
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ISSN:1541-6933
1556-0961
1556-0961
DOI:10.1007/s12028-022-01647-4