Current state of transfusion in traumatic brain injury and associated coagulopathy

Abstract

Traumatic brain injury (TBI)‐induced coagulopathy has long been recognized as a significant risk for poor outcomes in patients with TBI, but its pathogenesis remains poorly understood. As a result, current treatment options for the condition are limited and ineffective. The lack of information is most significant for the impact of blood transfusions on patients with isolated TBI and in the absence of confounding influences from trauma to the body and limbs and the resultant hemorrhagic shock. Here we discuss recent progress in understanding the pathogenesis of TBI‐induced coagulopathy and the current state of blood transfusions for patients with TBI and associated coagulopathy.

Whole blood at the tip of the spear: A retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties

“…This strong association, albeit not statistically significant, requires additional investigation and represents research and clinical opportunities to evaluate the effect of whole blood transfusion on the blood brain barrier, platelet function, mitigation of coagulopathy, or other factors that may impact outcomes. 36,37 The strong association we reported is in agreement with previous studies, which have shown increased transfusion of plasma or platelets is associated with improved outcomes in traumatic brain injury patients. 38,39 Our study supports the concept that hemostatic resuscitation may also improve outcomes in traumatic brain injury patientsdnot just systemic bleeding.…”

Early coagulopathy in children with isolated blunt head injury is associated with mortality and poor neurological outcomes

“…This finding is consistent with earlier reported incidences of coagulopathy ranging between 10% and 97% in combined pediatric and adult populations after various types of isolated TBI. 7,20,25,28 Based on our review of patient data, we excluded any patients who had prehospital or ED fluid administration to ensure that any deranged coagulopathy observed from initial ED blood investigations was likely primary. The coagulopathy profile is not confounded by hypothermia in Singapore due to the equatorial effect.…”

“…6,29 Our study findings were consistent with those of both adult and pediatric studies demonstrating that trauma-induced coagulopathy is associated with increased disability, as measured by GOS-E Peds and mortality. 4,17,23,25,26 Many studies define unfavorable neurological outcome as a GOS-E Peds score of 1 to 4, which includes death. In the analysis of neurological outcomes for survivors, this would be a potential confounder, especially if TBI-associated coagulopathy was already a known predictor of mortality.…”

“…1,28 Various mechanisms leading to hypocoagulability have been proposed to explain the pathogenesis of primary coagulopathy in isolated TBI, including hypothesized tissue factor release, protein C pathway activation, thrombocytopenia, and platelet dysfunction. 7,9,18,25,32,33 The incidence of and mechanisms resulting in acute coagulopathy differ between coagulopathies associated with penetrating injuries versus blunt head injuries. 10,28…”

“…With the exception of a small observational study (n = 66), 22 other reported studies on TBI-associated coagulopathy in the pediatric population used in-hospital outcome measures like death and ICU stay and did not address neurological outcomes, which is the critical focus of management for survivors with moderate to severe TBI. 3,21,25,28,29…”