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Relationship of Coagulopathy and Platelet Dysfunction to Transfusion Needs After Traumatic Brain Injury

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Abstract

Background

Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions.

Methods

We performed a retrospective study of patients admitted to the neuroscience intensive care unit of a level 1 trauma center from 2013 to 2015 with head Abbreviated Injury Scale ≥3. Patients were compared by mechanism of injury (blunt vs. penetrating). Admission demographics, injury characteristics, and laboratory parameters were evaluated. VerifyNow® Aspirin and P2Y12 tests were used for platelet function analysis.

Results

Five hundred and thirty-four patients were included in the analysis. There were no differences between groups in platelet count or international normalized ratio; however, patients with penetrating TBI were more coagulopathic by TEG, with all of the TEG parameters being significantly different except for R time. Patients with penetrating head trauma were not more likely than their blunt counterparts to have abnormal PFA results, and PFA results did not correlate with any TEG parameter in either group. The penetrating cohort received more units of blood products in the first 4 and 24 h than the blunt cohort.

Conclusions

Patients presenting with penetrating TBI demonstrated increased coagulopathy compared to those with blunt TBI as measured by TEG and need for transfusion. PFA results did not correlate with TEG findings in this population.

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Authors and Affiliations

  1. Division of Trauma/Critical Care, Department of Surgery, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA

    Grace Martin, Dhavan Shah, Nora Elson, Ryan Boudreau, Dennis Hanseman, Timothy A. Pritts, Amy T. Makley & Michael D. Goodman

  2. Division of Neurocritical Care, Department of Neurology, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267, USA

    Brandon Foreman

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  1. Grace Martin
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  2. Dhavan Shah
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  3. Nora Elson
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  4. Ryan Boudreau
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  5. Dennis Hanseman
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  6. Timothy A. Pritts
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  7. Amy T. Makley
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  9. Michael D. Goodman
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Correspondence to Michael D. Goodman.

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Martin, G., Shah, D., Elson, N. et al. Relationship of Coagulopathy and Platelet Dysfunction to Transfusion Needs After Traumatic Brain Injury. Neurocrit Care 28, 330–337 (2018). https://doi.org/10.1007/s12028-017-0485-5

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  • DOI: https://doi.org/10.1007/s12028-017-0485-5

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