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

Julia K Böhm, Helge Güting, Sophie Thorn, Nadine Schäfer, Victoria Rambach, Herbert Schöchl, Oliver Grottke, Rolf Rossaint, Simon Stanworth, Nicola Curry, Rolf Lefering, Marc Maegele, CENTER-TBI Participants and Investigators, Morten Blaabjerg (Member of author group), Martin Fabricius (Member of author group), Daniel Kondziella (Member of author group), Christina Rosenlund (Member of author group), Rico Frederik Schou (Member of author group)

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalNeurocritical Care
Volume35
Issue number1
Pages (from-to)184-196
ISSN1541-6933
DOIs
Publication statusPublished - Aug 2021

Bibliographical note

© 2020. The Author(s).

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