Coagulation disorders following acute head injury

Kumura, Eiji; Sato, Masaharu; Fukuda, Atsuhiro; Takemoto, Yoshinobu; Tanaka, Sh.; Kohama, Akitsugu

doi:10.1007/bf01402365

Cited by 57 publications

(19 citation statements)

References 22 publications

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“…These results are consistent with those from other studies conducted among adults, which have shown that low fibrinogen levels, elevated FDP, low platelet counts and delayed aPTT are predictors of a low GOS [5, 17]. In fact, the significant association between the changes in aPTT and FDP, and the outcome of patients with head injury, suggests that these hemocoagulative measures are good predictors of outcome [26, 27, 28]. We found a statistically significant association between aPTT, FDP and the outcome of the traumatized children, and the extent of statistical significance increased with the variation of these parameters.…”

Section: Discussionsupporting

confidence: 82%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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Background: Although disseminated intravascular coagulation (DIC) and other hemocoagulative abnormalities are severe complications of head injury, their effect on clinical outcome remains unclear, particularly among children. Objectives: To evaluate the frequency of hemocoagulative abnormalities and their influence on outcome among children with head injury. Study Design: We conducted a prospective observational study among 60 children with head injury, immediately evaluating severity of head injury (Glasgow Coma Scale, GCS); cerebral axial tomography; prothrombin time; activated partial thromboplastin time (aPTT); fibrinogen level; concentration of fibrin-fibrinogen degradation products (FDP), and platelet count. Two months after injury, we applied the Glasgow Outcome Score (GOS). Associations with GOS were evaluated using univariate and multivariate logistic models. Results: Among children with severe head injury, 22.2% (6/27) developed DIC, all of whom died and had shown severe brain edema. Among those with severe head injury yet without DIC, the mortality was only 14.2%. A low GOS was significantly and independently associated with a low GCS, multiple trauma, delayed aPTT, low fibrinogen level, elevated FDP and low platelet count. Brain edema was also associated with a low GOS, though not significantly. Conclusions: In addition to GCS, type of trauma, type of brain lesion and certain coagulation abnormalities are predictors of GOS.

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Section: Discussionsupporting

confidence: 82%

The Influence of Hemocoagulative Disorders on the Outcome of Children with Head Injury

et al. 2001

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“…There are variable data in the literature and different studies associated one or more of the following with TBI progression: Prothrombin time (PT) or INR, Partial thromboplastin time (PTT), thrombocytopenia, high fibrin degradation and low fibrinogen levels. [25][26][27][28][29][30] Fewer other studies reported no association between coagulopathy and bleeding progression in TBI. [31][32][33] This considerable variation is attributed to lack of consensus on TBI-coagulopathy definition, heterogeneity of patients involved, variable laboratory tests used in different studies and timing to perform these tests and CTs.…”

Section: Coagulopathy and Edhpmentioning

confidence: 98%

Epidural Hematoma Treated Conservatively: When to Expect the Worst

Basamh

Robert

Lamoureux

et al. 2015

Can. J. Neurol. Sci.

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Background: The Brain Trauma Foundation's 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of our sample and severe in 14.4%. Only 11.2% of the patients required surgery. Statistical comparison showed that younger age (p < 0.0001) and coagulopathy (p = 0.009) were the only significant factors for conversion to surgery. There was no difference in outcomes between patients who had EDHP and those who did not. Conclusions: Most traumatic EDH are not surgical at presentation. The rate of conversion to surgery is low. Significant predictors of EDHP are coagulopathy and younger age. These patients need closer observation because of a higher risk of EDHP. Outcome of surgical conversion was similar to successful conservative management.RÉSUMÉ: Hématome épidural traité de façon conservatrice : quand s'attendre au pire. Contexte : Les lignes directrices chirurgicales de la Brain Trauma Foundation de 2006 ont défini objectivement les patients atteints d'un hématome épidural (HÉD) qui peuvent être traités de façon conservatrice. Depuis lors, il n'existe pas dans la littérature d'indices adéquats pour identifier les patients qui sont à plus haut risque de progression de l'HÉD et chez qui un traitement chirurgical doit être envisagé. Le but de notre étude était d'identifier ces patients. Méthode : Nous avons effectué une revue rétrospective sur une période de 5 ans des dossiers de tous les patients atteints d'un HÉD qui ont été assignés initialement au traitement conservateur. Nous avons analysé les données démographiques, la sévérité de la lésion et son historique, l'état neurologique, la prise d'anticoagulants ou d'antiplaquettaires, les paramètres radiologiques, le recours à un traitement chirurgical et le moment où il a été réalisé ainsi que le score au Glasgow Outcome Scale. L'analyse bivariée ainsi que l'analyse de régression logistique ont été utilisées pour déterminer les facteurs de prédiction significatifs de la progression de l'HÉD et du recours à la chirurgie. Résultats : Cent vingt-cinq patients (75% des patients atteints d'un HÉD) ont été inclus dans l'étude. L'âge moyen des patients était de 39,1 ans. La lésion cérébrale étai...

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“…Recently, acute posttraumatic coagulopathy has been recognized as another major complication contributing to secondary brain injury and impaired outcome after TBI [3][4][5][6][7][8][9][10][11][12][13], but detailed information on its frequency and potential risk factors to aggravate the detrimental effects of this coagulopathy is still lacking. This retrospective analysis was conducted to assess the overall frequency of acute post-traumatic coagulopathy in patients with isolated blunt TBI, to evaluate its potential effects on outcome and to determine risk factors contributing to acute TBI-associated coagulopathy, all by using a large multi-center population-based trauma registry.…”

Section: Introductionmentioning

confidence: 99%