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Semin Thromb Hemost 2013; 39(08): 896-901
DOI: 10.1055/s-0033-1357484
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Traumatic Brain Injury and Its Effect on Coagulopathy

Sean P. McCully
1   Trauma Research Institute of Oregon (TRIO), Oregon Health & Science University, Portland, Oregon
,
Martin A. Schreiber
1   Trauma Research Institute of Oregon (TRIO), Oregon Health & Science University, Portland, Oregon
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Publikationsdatum:
10. Oktober 2013 (online)

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Abstract

Polytraumatic injury results in tissue factor (TF) release from damaged cells. The acute coagulopathy of trauma (ACT) occurs early and results from significant tissue injury and tissue hypoperfusion. ACT is augmented by therapies resulting in acidemia, hypothermia, and hemodilution contributing to trauma-induced coagulopathy. Coagulopathy associated with traumatic brain injury (TBI) results from the interplay of numerous variables. Because of the high concentration of TF in brain tissue, TBI has been believed to be associated with a greater degree of coagulopathy compared with injury in other body systems. TBI has also recently been shown to cause platelet dysfunction. Platelet receptor inhibition prevents cellular initiation and amplification of the clotting cascade, limiting thrombin incorporation, and stabilization of clot to stop hemorrhage. Therefore, head injury in the presence of polytrauma does appear to augment ACT and warrants close monitoring and appropriate intervention.

Keywords

trauma - hemostasis - coagulopathy - traumatic brain injury
 

  • References

  • 1 Penick GD, McLendon WW. Disorders of the hemostatic mechanism. Int Rec Med 1960; 173: 491-496
    PubMedGoogle Scholar
  • 2 Goodnight Jr SH. Defibrination following head injury. Compr Ther 1977; 3 (3) 25-28
    PubMedGoogle Scholar
  • 3 Goodnight SH, Kenoyer G, Rapaport SI, Patch MJ, Lee JA, Kurze T. Defibrination after brain-tissue destruction: A serious complication of head injury. N Engl J Med 1974; 290 (19) 1043-1047
    CrossrefPubMedGoogle Scholar
  • 4 MacGee EE, Bernell WR. Acute fibrinolysis following craniotomy and removal of metastatic tumor of the cerebellum. Case report. J Neurosurg 1970; 32 (5) 578-580
    PubMedGoogle Scholar
  • 5 Olson JD, Kaufman HH, Moake J , et al. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery 1989; 24 (6) 825-832
    CrossrefPubMedGoogle Scholar
  • 6 Talving P, Lustenberger T, Lam L , et al. Coagulopathy after isolated severe traumatic brain injury in children. J Trauma 2011; 71 (5) 1205-1210
    CrossrefPubMedGoogle Scholar
  • 7 Talving P, Benfield R, Hadjizacharia P, Inaba K, Chan LS, Demetriades D. Coagulopathy in severe traumatic brain injury: a prospective study. J Trauma 2009; 66 (1) 55-61 , discussion 61–62
    CrossrefPubMedGoogle Scholar
  • 8 Stein SC, Spettell C, Young G, Ross SE. Delayed and progressive brain injury in closed-head trauma: radiological demonstration. Neurosurgery 1993; 32 (1) 25-30 , discussion 30–31
    CrossrefPubMedGoogle Scholar
  • 9 Stein SC, Young GS, Talucci RC, Greenbaum BH, Ross SE. Delayed brain injury after head trauma: significance of coagulopathy. Neurosurgery 1992; 30 (2) 160-165
    CrossrefPubMedGoogle Scholar
  • 10 Stein SC, Spettell CM. Delayed and progressive brain injury in children and adolescents with head trauma. Pediatr Neurosurg 1995; 23 (6) 299-304
    CrossrefPubMedGoogle Scholar
  • 11 Langlois JA, Rutland-Brown W, Wald MM. The epidemiology and impact of traumatic brain injury: a brief overview. J Head Trauma Rehabil 2006; 21 (5) 375-378
    CrossrefPubMedGoogle Scholar
  • 12 Laroche M, Kutcher ME, Huang MC, Cohen MJ, Manley GT. Coagulopathy after traumatic brain injury. Neurosurgery 2012; 70 (6) 1334-1345
    CrossrefPubMedGoogle Scholar
  • 13 Rosenfeld JV, Maas AI, Bragge P, Morganti-Kossmann MC, Manley GT, Gruen RL. Early management of severe traumatic brain injury. Lancet 2012; 380 (9847) 1088-1098
    CrossrefPubMedGoogle Scholar
  • 14 Maegele M. Coagulopathy after traumatic brain injury: incidence, pathogenesis, and treatment options. Transfusion 2013; 53 (Suppl. 01) 28S-37S
    CrossrefPubMedGoogle Scholar
  • 15 Nekludov M, Antovic J, Bredbacka S, Blombäck M. Coagulation abnormalities associated with severe isolated traumatic brain injury: cerebral arterio-venous differences in coagulation and inflammatory markers. J Neurotrauma 2007; 24 (1) 174-180
    CrossrefPubMedGoogle Scholar
  • 16 Decuypere M, Klimo Jr P. Spectrum of traumatic brain injury from mild to severe. Surg Clin North Am 2012; 92 (4) 939-957 , ix
    CrossrefPubMedGoogle Scholar
  • 17 Coronado VG, Xu L, Basavaraju SV , et al; Centers for Disease Control and Prevention (CDC). Surveillance for traumatic brain injury-related deaths—United States, 1997-2007. MMWR Surveill Summ 2011; 60 (5) 1-32
    Google Scholar
  • 18 Greuters S, van den Berg A, Franschman G , et al; ALARM-BLEEDING investigators. Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury. Crit Care 2011; 15 (1) R2
    CrossrefPubMedGoogle Scholar
  • 19 Carrick MM, Tyroch AH, Youens CA, Handley T. Subsequent development of thrombocytopenia and coagulopathy in moderate and severe head injury: support for serial laboratory examination. J Trauma 2005; 58 (4) 725-729 , discussion 729–730
    CrossrefPubMedGoogle Scholar
  • 20 Wafaisade A, Lefering R, Tjardes T , et al; Trauma Registry of DGU. Acute coagulopathy in isolated blunt traumatic brain injury. Neurocrit Care 2010; 12 (2) 211-219
    CrossrefPubMedGoogle Scholar
  • 21 Kaufmann CR, Dwyer KM, Crews JD, Dols SJ, Trask AL. Usefulness of thrombelastography in assessment of trauma patient coagulation. J Trauma 1997; 42 (4) 716-720 , discussion 720–722
    CrossrefPubMedGoogle Scholar
  • 22 Shore-Lesserson L, Manspeizer HE, DePerio M, Francis S, Vela-Cantos F, Ergin MA. Thromboelastography-guided transfusion algorithm reduces transfusions in complex cardiac surgery. Anesth Analg 1999; 88 (2) 312-319
    CrossrefPubMedGoogle Scholar
  • 23 McNicol PL, Liu G, Harley ID , et al. Patterns of coagulopathy during liver transplantation: experience with the first 75 cases using thrombelastography. Anaesth Intensive Care 1994; 22 (6) 659-665
    PubMedGoogle Scholar
  • 24 Davis PK, Musunuru H, Walsh M , et al. Platelet dysfunction is an early marker for traumatic brain injury-induced coagulopathy. Neurocrit Care 2013; 18 (2) 201-208
    CrossrefPubMedGoogle Scholar
  • 25 Silver J, McAllister T, Yodofsky S. Textbook of Traumatic Brain Injury. Arlington, VA: American Psychiatric Publishing; 2005: 27-39
    Google Scholar
  • 26 Kurland D, Hong C, Aarabi B, Gerzanich V, Simard JM. Hemorrhagic progression of a contusion after traumatic brain injury: a review. J Neurotrauma 2012; 29 (1) 19-31
    CrossrefPubMedGoogle Scholar
  • 27 Sugawara T, Jadhav V, Ayer R, Chen W, Suzuki H, Zhang JH. Thrombin inhibition by argatroban ameliorates early brain injury and improves neurological outcomes after experimental subarachnoid hemorrhage in rats. Stroke 2009; 40 (4) 1530-1532
    CrossrefPubMedGoogle Scholar
  • 28 Morel N, Morel O, Petit L , et al. Generation of procoagulant microparticles in cerebrospinal fluid and peripheral blood after traumatic brain injury. J Trauma 2008; 64 (3) 698-704
    CrossrefPubMedGoogle Scholar
  • 29 Lok J, Leung W, Murphy S, Butler W, Noviski N, Lo EH. Intracranial hemorrhage: mechanisms of secondary brain injury. Acta Neurochir Suppl (Wien) 2011; 111: 63-69
    PubMedGoogle Scholar
  • 30 Cohen MJ, Brohi K, Ganter MT, Manley GT, Mackersie RC, Pittet JF. Early coagulopathy after traumatic brain injury: the role of hypoperfusion and the protein C pathway. J Trauma 2007; 63 (6) 1254-1261 , discussion 1261–1262
    CrossrefPubMedGoogle Scholar
  • 31 Stein SC, Smith DH. Coagulopathy in traumatic brain injury. Neurocrit Care 2004; 1 (4) 479-488
    CrossrefPubMedGoogle Scholar
  • 32 Gando S, Nanzaki S, Kemmotsu O. Coagulofibrinolytic changes after isolated head injury are not different from those in trauma patients without head injury. J Trauma 1999; 46 (6) 1070-1076 , discussion 1076–1077
    CrossrefPubMedGoogle Scholar
  • 33 Chu AJ. Tissue factor, blood coagulation, and beyond: an overview. Int J Inflamm 2011; 2011: 367284
    PubMedGoogle Scholar
  • 34 Østerud B, Bjørklid E. Sources of tissue factor. Semin Thromb Hemost 2006; 32 (1) 11-23
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Halpern CH, Reilly PM, Turtz AR, Stein SC. Traumatic coagulopathy: the effect of brain injury. J Neurotrauma 2008; 25 (8) 997-1001
    CrossrefPubMedGoogle Scholar
  • 36 MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma 2003; 55 (1) 39-44
    CrossrefPubMedGoogle Scholar
  • 37 Lustenberger T, Talving P, Kobayashi L , et al. Time course of coagulopathy in isolated severe traumatic brain injury. Injury 2010; 41 (9) 924-928
    CrossrefPubMedGoogle Scholar
  • 38 Franschman G, Boer C, Andriessen TM , et al. Multicenter evaluation of the course of coagulopathy in patients with isolated traumatic brain injury: relation to CT characteristics and outcome. J Neurotrauma 2012; 29 (1) 128-136
    CrossrefPubMedGoogle Scholar
  • 39 Genet GF, Johansson PI, Meyer MA , et al. Trauma induced coagulopathy: Standard coagulation tests, biomarkers of coagulopathy and endothelial damage in patients with traumatic brain injury. J Neurotrauma 2013; 30 (4) 301-306
    CrossrefPubMedGoogle Scholar
  • 40 Brohi K, Singh J, Heron M, Coats T. Acute traumatic coagulopathy. J Trauma 2003; 54 (6) 1127-1130
    CrossrefPubMedGoogle Scholar
  • 41 Frith D, Goslings JC, Gaarder C , et al. Definition and drivers of acute traumatic coagulopathy: clinical and experimental investigations. J Thromb Haemost 2010; 8 (9) 1919-1925
    CrossrefPubMedGoogle Scholar
  • 42 Lustenberger T, Talving P, Kobayashi L , et al. Early coagulopathy after isolated severe traumatic brain injury: relationship with hypoperfusion challenged. J Trauma 2010; 69 (6) 1410-1414
    CrossrefPubMedGoogle Scholar
  • 43 Harhangi BS, Kompanje EJ, Leebeek FW, Maas AI. Coagulation disorders after traumatic brain injury. Acta Neurochir (Wien) 2008; 150 (2) 165-175 , discussion 175
    CrossrefPubMedGoogle Scholar
  • 44 Franschman G, Greuters S, Jansen WH , et al. Haemostatic and cranial computed tomography characteristics in patients with acute and delayed coagulopathy after isolated traumatic brain injury. Brain Inj 2012; 26 (12) 1464-1471
    CrossrefPubMedGoogle Scholar