Detecting Traumatic Brain Injury-Induced Coagulopathy: What We Are Testing and What We Are Not

Abstract

Coagulopathy after traumatic brain injury (TBI) is common and has been closely associated with poor clinical outcomes for the affected patients. Traumatic brain injury-induced coagulopathy (TBI-IC) is consumptive in nature and evolves rapidly from an injury-induced hypercoagulable state. Traumatic brain injury-induced coagulopathy defined by laboratory tests is significantly more frequent than clinical coagulopathy, which often manifests as secondary, recurrent, or delayed intracranial or intracerebral hemorrhage. This disparity between laboratory and clinical coagulopathies has hindered progress in understanding the pathogenesis of TBI-IC and developing more accurate and predictive tests for this severe TBI complication. In this review, we discuss laboratory tests used in clinical and research studies to define TBI-IC, with specific emphasis on what the tests detect and what they do not. We also offer perspective on developing more accurate and predictive tests for this severe TBI complication.

Age, admission platelet count, and mortality in severe isolated traumatic brain injury: A retrospective cohort study

“…7,22,23 In addition, although more recent work has tended to focus on the documentation and assessment of trauma-associated platelet dysfunction, plateletassociated disturbances-in function and numbersappear to be common and specific to TBI [24][25][26][27][28][29][30][31][32][33][34] but overall are frustratingly poorly correlated with clinical observations of bleeding. 35 However, despite the marked excess risk for TBI and TBI mortality with aging, 3,4 few studies have attempted to isolate the potential independent associations of age with platelet dysfunction in TBI, tending instead to bin such effects with medication and/or comorbidities and/or to bin TBI with other severe trauma.…”

Letter to the editor for “Detecting traumatic brain injury-induced coagulopathy: What we are testing and what we are not”

“…W e recently read the article by Grigorian et al, 1 which examined the timing of antibiotic administration in open lower extremity fractures and the associated risk of developing an infection while in the hospital. These injuries represent a substantial burden in the traumatized population and are often the bane of the treating orthopedic surgeon because of the high rates of infection and subsequent nonunion.…”

“…We read with great interest the recent review article by Dong et al 1 on the role of diagnostic tests in detecting isolated traumatic brain injury (iTBI)–induced coagulopathy. The authors emphasized the distinct nature of the iTBI-induced coagulopathy pathophysiology compared with the coagulopathy observed in patients with severe multiorgan trauma and hypovolemic shock.…”