Coagulopathy in moderate head injury. The role of early administration of low molecular weight heparin

Pahatouridis, Dimitrios; Alexiou, George Α.; Zigouris, Andreas; Mihos, Evaggelos; Drosos, Dimitrios; Voulgaris, Spyridon

doi:10.3109/02699052.2010.490510

Cited by 36 publications

(44 citation statements)

References 19 publications

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“…This lack of understanding has greatly slowed the pace of developing effective therapeutics targeting this potentially lethal pathological state. As a result, clinical trials on the efficacy of anti-thrombin III, (147) low-molecular weight heparin, (148)(149)(150) factor VIIa, (151,152) and prostacyclin (153,154) have yielded variable outcomes in the setting of TBI and associated pathologies. The transfusion of blood products, such as platelets, fresh frozen plasma, and cryoprecipitate, has been a standard treatment.…”

Section: Resultsmentioning

confidence: 99%

Traumatic Brain Injury-Associated Coagulopathy

Zhang

Jiang

Liu

et al. 2012

Journal of Neurotrauma

129

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Traumatic injury is a common cause of coagulopathy, primarily due to blood loss and hemodilution secondary to fluid resuscitation. Traumatic injury-associated coagulopathy often follows a course of transition from hyper- to hypocoagulable state exemplified in disseminated intravascular coagulation. The incidence of coagulopathy is significantly higher in patients with traumatic brain injury (TBI), especially those with penetrating trauma compared to injury to the trunk and limbs. This occurs despite the fact that patients with isolated TBI bleed less and receive restricted volume load of fluids. TBI-associated coagulopathy is extensively documented to associate with poor clinical outcomes, but its pathophysiology remains poorly understood. Studies in the past have shown that brain tissue is highly enriched in key procoagulant molecules. This review focuses on the biochemical and cellular characteristics of these molecules and pathways that could make brain uniquely procoagulant and prone to coagulopathy. Understanding this unique procoagulant environment will help to identify new therapeutic targets that could reverse a state of coagulopathy with minimal impacts on hemostasis, a critical requirement for neurosurgical treatments of TBI.

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Section: Resultsmentioning

confidence: 99%

Traumatic Brain Injury-Associated Coagulopathy

Zhang

Jiang

Liu

et al. 2012

Journal of Neurotrauma

129

View full text Add to dashboard Cite

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“…Furthermore, novel diagnostic tools may enhance our insight into the contribution of fibrinogen and platelets to clot formation and fibrinolysis, thereby enhancing our knowledge about the pathophysiological mechanisms underlying the development of coagulopathy in isolated TBI. Moreover, the insufficient evidence for the effectiveness of administration of coagulation factors like heparin, antifibrinolytics, or recombinant factor VII, as treatment for TBI-associated coagulopathy, prohibits the design of an effective therapeutic regimen in these patients (Pahatouridis et al, 2010;Perel et al, 2010).…”

Section: Discussionmentioning

confidence: 99%

Multicenter Evaluation of the Course of Coagulopathy in Patients with Isolated Traumatic Brain Injury: Relation to CT Characteristics and Outcome

Franschman

Boer

Andriessen

et al. 2012

Journal of Neurotrauma

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This prospective multicenter study investigated the association of the course of coagulation abnormalities with initial computed tomography (CT) characteristics and outcome in patients with isolated traumatic brain injury (TBI). Patient demographics, coagulation parameters, CT characteristics, and outcome data of moderate and severe TBI patients without major extracranial injuries were prospectively collected. Coagulopathy was defined as absent, early but temporary, delayed, or early and sustained. Delayed/sustained coagulopathy was associated with a higher incidence of disturbed pupillary responses (40% versus 27%; p < 0.001) and higher Traumatic Coma Data Bank (TCDB) CT classification (5 (2-5) versus 2 (1-5); p = 0.003) than in patients without or with early, but short-lasting coagulopathy. The initial CT of patients with delayed/sustained coagulopathy more frequently showed intracranial hemorrhage and signs of raised intracranial pressure (ICP) compared to patients with early coagulopathy only. This was paralleled by higher in-hospital mortality rates (51% versus 33%; p < 0.05), and poorer 6-month functional outcome in patients with delayed/sustained coagulopathy. The relative risk for inhospital mortality was particularly related to disturbed pupillary responses (OR 8.19; 95% CI 3.15,21.32; p < 0.001), early, short-lasting coagulopathy (OR 6.70; 95% CI 1.74,25.78; p = 0.006), or delayed/sustained coagulopathy (OR 5.25; 95% CI 2.06,13.40; p = 0.001). Delayed/sustained coagulopathy is more frequently associated with CT abnormalities and unfavorable outcome at 6 months after TBI than early, short-lasting coagulopathy. Our finding that not only the mere presence but also the time course of coagulopathy holds predictive value for patient outcome underlines the importance of systematic hemostatic monitoring over time in TBI.

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“…Coagulopathy after traumatic brain injury (TBI) is a frequent event and is associated with patients' prognosis [1,2]. About 22-93% of patients with TBI have been reported to develop coagulopathy [2,3].…”

Section: Introductionmentioning

confidence: 99%

Admission glucose and coagulopathy occurrence in patients with traumatic brain injury

Alexiou¹,

Lianos

Fotakopoulos³

et al. 2014

Brain Injury

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Coagulopathy in moderate head injury. The role of early administration of low molecular weight heparin

Abstract: Patients with moderate TBI are at a serious risk of developing brain intravascular microthrombosis. Our study supports the early use of low molecular weight heparin.

Cited by 36 publications

References 19 publications

Traumatic Brain Injury-Associated Coagulopathy

Traumatic Brain Injury-Associated Coagulopathy

Multicenter Evaluation of the Course of Coagulopathy in Patients with Isolated Traumatic Brain Injury: Relation to CT Characteristics and Outcome

Admission glucose and coagulopathy occurrence in patients with traumatic brain injury

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