Transfusion in Traumatic Brain Injury

Reddy, G. Duemani; Gopinath, Shankar P.; Robertson, Claudia S.

doi:10.1007/s11940-015-0379-9

Cited by 12 publications

(5 citation statements)

References 43 publications

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“…9,30,41 Still, others warn for the use of transfusion considering the possibility of complications of transfusion and unknown effects on (functional) outcome. 42 Also for coagulation (enhancing) products larger studies are needed to prove a positive balance between the beneficial effects in terms of patient outcome and adverse effects on (thromboembolic) complications. 27,28,[42][43][44][45] New evidence is clearly needed on these topics, since control of blood and coagulation status could have a large impact on patient outcome, especially in patients with TBI.…”

Section: Thrombosis (Dvt) Prophylaxis With Anticoagulants Minimum Plmentioning

confidence: 99%

Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study

Huijben

Jagt

Cnossen

et al. 2018

Journal of Neurotrauma

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Our aim was to describe current approaches and to quantify variability between European intensive care units (ICUs) in patients with traumatic brain injury (TBI). Therefore, we conducted a provider profiling survey as part of the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study. The ICU Questionnaire was sent to 68 centers from 20 countries across Europe and Israel. For this study, we used ICU questions focused on 1) hemoglobin target level (Hb-TL), 2) coagulation management, and 3) deep venous thromboembolism (DVT) prophylaxis. Seventy-eight participants, mostly intensivists and neurosurgeons of 66 centers, completed the ICU questionnaire. For ICU-patients, half of the centers (N = 34; 52%) had a defined Hb-TL in their protocol. For patients with TBI, 26 centers (41%) indicated an Hb-TL between 70 and 90 g/L and 38 centers (59%) above 90 g/L. To treat trauma-related hemostatic abnormalities, the use of fresh frozen plasma (N = 48; 73%) or platelets (N = 34; 52%) was most often reported, followed by the supplementation of vitamin K (N = 26; 39%). Most centers reported using DVT prophylaxis with anticoagulants frequently or always (N = 62; 94%). In the absence of hemorrhagic brain lesions, 14 centers (21%) delayed DVT prophylaxis until 72 h after trauma. If hemorrhagic brain lesions were present, the number of centers delaying DVT prophylaxis for 72 h increased to 29 (46%). Overall, a lack of consensus exists between European ICUs on blood transfusion and coagulation management. The results provide a baseline for the CENTER-TBI study, and the large between-center variation indicates multiple opportunities for comparative effectiveness research.

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Section: Thrombosis (Dvt) Prophylaxis With Anticoagulants Minimum Plmentioning

confidence: 99%

Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study

Huijben

Jagt

Cnossen

et al. 2018

Journal of Neurotrauma

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“…A recent re-analysis of the SAFE data (33) in the subgroup of TBI patients showed albumin infusion was directly related to higher intracranial pressure (ICP) and worse outcome (34). Blood components should be supplied, to optimize oxygen delivery with an adequate hemoglobin level and restore coagulation in hemorrhagic patients (35). …”

Section: Neuroprotection At the Bedsidementioning

confidence: 99%

Rethinking Neuroprotection in Severe Traumatic Brain Injury: Toward Bedside Neuroprotection

et al. 2017

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Neuroprotection after traumatic brain injury (TBI) is an important goal pursued strenuously in the last 30 years. The acute cerebral injury triggers a cascade of biochemical events that may worsen the integrity, function, and connectivity of the brain cells and decrease the chance of functional recovery. A number of molecules acting against this deleterious cascade have been tested in the experimental setting, often with preliminary encouraging results. Unfortunately, clinical trials using those candidate neuroprotectants molecules have consistently produced disappointing results, highlighting the necessity of improving the research standards. Despite repeated failures in pharmacological neuroprotection, TBI treatment in neurointensive care units has achieved outcome improvement. It is likely that intensive treatment has contributed to this progress offering a different kind of neuroprotection, based on a careful prevention and limitations of intracranial and systemic threats. The natural course of acute brain damage, in fact, is often complicated by additional adverse events, like the development of intracranial hypertension, brain hypoxia, or hypoperfusion. All these events may lead to additional brain damage and worsen outcome. An approach designed for early identification and prompt correction of insults may, therefore, limit brain damage and improve results.

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“…MPs expressing TF (CD144 and CD142), platelet-derived MPs expressing P-selectin (CD42a and CD62P) [197,248]. [256].…”

Section: Platelets In General Trauma and Tbimentioning

confidence: 99%

Formation of Microparticles in the Injured Brain of Patients with Severe Isolated Traumatic Brain Injury

Nekludov

Mobarrez²,

Gryth³

et al. 2014

Journal of Neurotrauma

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The potential pathophysiological role of circulating microparticles (MPs) has been recognized in various conditions, such as cardiovascular and thrombotic diseases. Traumatic brain injury (TBI) has a complex pathophysiology that involves coagulopathy and inflammation. We investigated endothelial-, platelet-, and leukocyte-derived microparticles (EMPs, PMPs, and LMPs, respectively) in 16 patients with severe isolated TBI. Arterial and cerebrovenous samples were taken repeatedly, during 1-72 h after injury. Subpopulations of MPs, exposing tissue factor (TF) and P-selection, were also studied. MP counts in cerebrovenous samples, irrespective of cellular origin, were higher in TBI cases, compared to healthy controls (peak levels of EMPs were approximately 7 times higher, PMPs 1.4 times higher, and LMPs 2 times higher, respectively; p<0.001 for all). MP counts declined sharply from high levels shortly after the trauma toward slightly elevated levels 72 h later. EMPs and PMPs exposing TF, as well as PMPs exposing P-selection, showed a transcranial gradient with higher concentration in cerebrovenous, compared to arterial, samples. In contrast, LMPs exposing TF were higher in arterial samples, suggesting accumulation of LMPs in the brain. We conclude that the pattern of circulating MPs is altered after TBI. PMPs exposing P-selection and EMPs exposing TF seem to be generated in the injured brain, whereas LMPs exposing TF are accumulated. The pathophysiological significance of these changes in MP pattern in TBI should be further investigated. Including MPs exposing brain-specific antigens in the assessment of brain injury would give further information of origin and likely give additional information of the size of the injury, given that the MP phenotypes investigated in the present study are not brain-specific markers.

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Transfusion in Traumatic Brain Injury

Cited by 12 publications

References 43 publications

Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study

Variation in Blood Transfusion and Coagulation Management in Traumatic Brain Injury at the Intensive Care Unit: A Survey in 66 Neurotrauma Centers Participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury Study

Rethinking Neuroprotection in Severe Traumatic Brain Injury: Toward Bedside Neuroprotection

Formation of Microparticles in the Injured Brain of Patients with Severe Isolated Traumatic Brain Injury

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