Thrombelastography-identified coagulopathy is associated with increased morbidity and mortality after traumatic brain injury

Am J Surg. 2012 May;203(5):584-588. doi: 10.1016/j.amjsurg.2011.12.011. Epub 2012 Mar 15.

Abstract

Background: The purpose of this study was to determine the relationship between coagulopathy and outcome after traumatic brain injury.

Methods: Patients admitted with a traumatic brain injury were enrolled prospectively and admission blood samples were obtained for kaolin-activated thrombelastogram and standard coagulation assays. Demographic and clinical data were obtained for analysis.

Results: Sixty-nine patients were included in the analysis. A total of 8.7% of subjects showed hypocoagulability based on a prolonged time to clot formation (R time, > 9 min). The mortality rate was significantly higher in subjects with a prolonged R time at admission (50.0% vs 11.7%). Patients with a prolonged R time also had significantly fewer intensive care unit-free days (8 vs 27 d), hospital-free days (5 vs 24 d), and increased incidence of neurosurgical intervention (83.3% vs 34.9%).

Conclusions: Hypocoagulability as shown by thrombelastography after traumatic brain injury is associated with worse outcomes and an increased incidence of neurosurgical intervention.

MeSH terms

  • Adult
  • Blood Coagulation Disorders / diagnosis*
  • Blood Coagulation Disorders / etiology*
  • Brain Injuries / complications*
  • Brain Injuries / mortality*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Thrombelastography*