gms | German Medical Science

Objective: The goal of this study is to determine the relationship of coagulopathy and outcome in patients with isolated severe traumatic brain injury (TBI).

Method: Patients admitted with a TBI without major extracranial injuries were enrolled prospectively. The following data were collected: patients’ demographics, initial GCS and pupillary responses, coagulation parameters (INR, PTT, fibrinogen, D-dimers, platelet account and factor XIII level), initial and follow-up CT characteristics, as well as outcome data using the modified Rankin score and Glasgow outcome score. Functional outcome was determined at the time of discharge and 6 month later.

Results: A total of 227 patients sustaining isolated TBI were included in the analysis. 61 patients (26.9%) showed an early coagulopathy (< 6 h posttraumatic) which was sustained in 48 cases (21.1%) for many days. 44 patients (19.4%) developed only a delayed coagulopathy (> 6 h posttraumatic). Fibrinogen was the most affected coagulation factor in our analysis (52%). The correlation between the initial and follow-up CT scans of patients with early/sustained coagulopathy showed progressive traumatic intracerebral hemorrhages more frequently than in patients with early/short-lasting coagulation and patients with delayed coagulopathy. 12 patients (5.2%) who were not under treatment with anticoagulants or platelet inhibitors demonstrated platelet dysfunction detected using platelet function analyzer (PFA-100). In addition, the in-hospital mortality rate (42 patients, 18.5%) significantly increased in the early coagulopathy patients' group (27/42 patients, 64.2%) compared to the other groups with delayed coagulopathy or without coagulopathy (15/42, 35.8%). Patients’ functional outcome showed the highest percentage of severe disability – mRS 4 or 5 – occurring in the early/sustained coagulopathy group (75.5% of severe disability cases). Furthermore, patients with early/sustained coagulopathy had the longest ICU stay (18.3 vs. 4 d) and ventilation time (320 vs. 68 h).

Conclusions: In Patients with TBI early/sustained coagulopathy is more frequently associated with progressive traumatic intracerebral hemorrhage, with longer ICU stay, and unfavorable outcome than delayed or early/short-lasting coagulopathy. These data emphasize the importance of initial comprehensive analysis of the coagulation status. A rapid correction of early coagulopathy has to be an indispensable part of the treatment of TBI patients to improve their short- and long-time prognosis.