Extended Coagulation Profling in Isolated Traumatic Brain Injury: A CENTER-TBI Analysis

• Published in: Neurocritical care 2021
• Main Authors: Böhm, Julia K, Schaeben, Victoria, Schäfer, Nadine, Güting, Helge, Lefering, Rolf, Thorn, Sophie, Schöchl, Herbert, Zipperle, Johannes, Grottke, Oliver, Rossaint, Rolf, Stanworth, Simon, Curry, Nicola, Maegele, Mark, Andelic, Nada, Andreassen, Lasse, Anke, Audny Gabriele Wagner, Frisvold, Shirin, Helseth, Eirik, Røe, Cecilie, Røise, Olav, Skandsen, Toril, Vik, Anne, Åkerlund, Cecilia, Amrein, Krisztina, Antoni, Anna, Audibert, Gerard, Azouvi, Philippe, Azzolini, Maria luisa, Bartels, Ronald, Barzo, Pal, Beauvais, Romuald, Beer, Ronny, Bellander, Bo-michael, Belli, Antonio, Benali, Habib, Berardino, Maurizio, Beretta, Luigi, Blaabjerg, Morten, Bragge, Peter, Brazinova, Alexandra, Brinck, Vibeke, Brooker, Joanne, Brorsson, Camilla, Buki, Andras, Bullinger, Monika, Cabeleira, Manuel, Caccioppola, Alessio, Calvi, Maria rosa, Cameron, Peter, Lozano, Guillermo carbayo, Carbonara, Marco, Chevallard, Giorgio
• Format: Article
• Language: Norwegian
• ISSN: 1541-6933; 1556-0961

Background Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. Methods Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) (n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR  1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick’s value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers. Results Patients with iTBI with INR ≥ 1.2 (n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR