The Impact of Platelets on the Progression of Traumatic Intracranial Hemorrhage

Schnüriger, Beat; Inaba, Kenji; Abdelsayed, George A.; Lustenberger, Thomas; Eberle, Barbara M.; Barmparas, Galinos; Talving, Peep; Δημητριάδης, Δημήτριος

doi:10.1097/ta.0b013e3181d3cc58

Cited by 121 publications

(70 citation statements)

References 25 publications

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“…Unsurprisingly, a lower platelet count is associated with increased bleeding, progression of intracranial hemorrhage, and mortality. 42,43 However, it is clear that platelet dysfunction can occur when the platelet count is well within the reference range, preventing simple reliance on platelet count to guide therapy. 44 Viscoelastic tests provide some information on platelet function, but the angle and maximum amplitude/clot firmness variables on TEG and rotational thromboelastometry (ROTEM) are also dependent on fibrinogen levels, 45 and these tests are furthermore not effective at detecting inhibition by antiplatelet agents.…”

Section: Platelet Dysfunctionmentioning

confidence: 99%

Advances in the understanding of trauma-induced coagulopathy

Chang

Cardenas

Wade

et al. 2016

Blood

246

225

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Ten percent of deaths worldwide are due to trauma, and it is the third most common cause of death in the United States. Despite a profound upregulation in procoagulant mechanisms, one-quarter of trauma patients present with laboratory-based evidence of trauma-induced coagulopathy (TIC), which is associated with poorer outcomes including increased mortality. The most common causes of death after trauma are hemorrhage and traumatic brain injury (TBI). The management of TIC has significant implications in both because many hemorrhagic deaths could be preventable, and TIC is associated with progression of intracranial injury after TBI. This review covers the most recent evidence and advances in our understanding of TIC, including the role of platelet dysfunction, endothelial activation, and fibrinolysis. Trauma induces a plethora of biochemical and physiologic changes, and despite numerous studies reporting differences in coagulation parameters between trauma patients and uninjured controls, it is unclear whether some of these differences may be “normal” after trauma. Comparisons between trauma patients with differing outcomes and use of animal studies have shed some light on this issue, but much of the data continue to be correlative with causative links lacking. In particular, there are little data linking the laboratory-based abnormalities with true clinically evident coagulopathic bleeding. For these reasons, TIC continues to be a significant diagnostic and therapeutic challenge.

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Section: Platelet Dysfunctionmentioning

confidence: 99%

Advances in the understanding of trauma-induced coagulopathy

Chang

Cardenas

Wade

et al. 2016

Blood

246

225

View full text Add to dashboard Cite

show abstract

“…The reported incidence of PHI ranges from 20-60% (Chang et al, 2006;Chieregato et al, 2005;Engstrom et al, 2005;Narayan et al, 2008;Oertel et al, 2002;Sanus et al, 2004;Schnuriger et al, 2010;Seifman et al, 2011;Servadei et al, 2000;Tong et al, 2011). The wide variation is due to different evaluation and enrollment criteria at different research centers.…”

mentioning

confidence: 99%

Predicting Progressive Hemorrhagic Injury after Traumatic Brain Injury: Derivation and Validation of a Risk Score Based on Admission Characteristics

Yuan

Ding

Chen

et al. 2012

Journal of Neurotrauma

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Previous studies have demonstrated that patients with traumatic brain injury (TBI) who also have progressive hemorrhagic injury (PHI), have a higher risk of clinical deterioration and worse outcomes than do TBI patients without PHI. Therefore, the early prediction of PHI occurrence is useful to evaluate the status of patients with TBI and to improve outcomes. The objective of this study was to develop and validate a prognostic model that uses information available at admission to determine the likelihood of PHI after TBI. Retrospectively collected data were used to develop a PHI prognostic model with a logistic regression analysis. The prediction model was validated in 114 patients from a separate hospital. Eight independent prognostic factors were identified: age ‡ 57 years (5 points), intra-axial bleeding/brain contusion (4 points), midline shift ‡ 5 mm (6 points), platelet (PLT) count < 100 · 10 9 /L (10 points), PLT count ‡ 100 but < 150 · 10 9 /L (4 points), prothrombin time > 14 sec (7 points), D-dimer ‡ 5 mg/L (12 points), and glucose ‡ 10 mmol/L (10 points). Each patient was assigned a number of points proportional to the regression coefficient. We calculated risk scores for each patient and defined three risk groups: low risk (0-13 points), intermediate risk (14-22 points), and high risk (23-54 points). In the development cohort, the PHI rates after TBI for these three groups were 10.3%, 47.3%, and 85.2%, respectively. In the validation cohort, the corresponding PHI rates were 10.9%, 47.3%, and 86.9%. The C-statistic for the point system was 0.864 ( p = 0.509 by the Hosmer-Lemeshow test) in the development cohort, and 0.862 ( p = 0.589 by the Hosmer-Lemeshow test) in the validation cohort. In conclusion, a relatively simple risk score using admission predictors accurately predicted the risk for PHI after TBI.

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“…Abnormalities in admission PT, aPTT, INR, and fibrinogen degradation products have all been linked to increased morbidity and mortality in TBI patients [3,4,7,12,27,28,[32][33][34][35][36][37]. However, when we analyzed admission CCT values on 1924 of our highest-level trauma activations over 18 months, no statistically significant difference in the prevalence of coagulopathy based on these values was detected in TBI patients compared to non-TBI patients (Table 2).…”

Section: Discussionmentioning

confidence: 83%

“…A variety of mechanisms have been hypothesized including alterations in the release of tissue factor, platelet dysfunction, consumptive coagulopathy, and the activation of protein C pathways secondary to hypoperfusion [12,[23][24][25][26][27][28][29][30][31].…”

Section: Discussionmentioning

confidence: 99%