Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis.
CENTER-TBI
Coagulopathy
Risk factors
Traumatic brain injury
Journal
Neurocritical care
ISSN: 1556-0961
Titre abrégé: Neurocrit Care
Pays: United States
ID NLM: 101156086
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
received:
16
07
2020
accepted:
03
11
2020
pubmed:
12
12
2020
medline:
30
9
2021
entrez:
11
12
2020
Statut:
ppublish
Résumé
Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood. This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis. Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to - 6, hypothermia and hypotension increased risk significantly. Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.
Sections du résumé
BACKGROUND
Trauma-induced coagulopathy in patients with traumatic brain injury (TBI) is associated with high rates of complications, unfavourable outcomes and mortality. The mechanism of the development of TBI-associated coagulopathy is poorly understood.
METHODS
This analysis, embedded in the prospective, multi-centred, observational Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, aimed to characterise the coagulopathy of TBI. Emphasis was placed on the acute phase following TBI, primary on subgroups of patients with abnormal coagulation profile within 4 h of admission, and the impact of pre-injury anticoagulant and/or antiplatelet therapy. In order to minimise confounding factors, patients with isolated TBI (iTBI) (n = 598) were selected for this analysis.
RESULTS
Haemostatic disorders were observed in approximately 20% of iTBI patients. In a subgroup analysis, patients with pre-injury anticoagulant and/or antiplatelet therapy had a twice exacerbated coagulation profile as likely as those without premedication. This was in turn associated with increased rates of mortality and unfavourable outcome post-injury. A multivariate analysis of iTBI patients without pre-injury anticoagulant therapy identified several independent risk factors for coagulopathy which were present at hospital admission. Glasgow Coma Scale (GCS) less than or equal to 8, base excess (BE) less than or equal to - 6, hypothermia and hypotension increased risk significantly.
CONCLUSION
Consideration of these factors enables early prediction and risk stratification of acute coagulopathy after TBI, thus guiding clinical management.
Identifiants
pubmed: 33306177
doi: 10.1007/s12028-020-01151-7
pii: 10.1007/s12028-020-01151-7
pmc: PMC8285342
doi:
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
184-196Investigateurs
Cecilia Åkerlund
(C)
Krisztina Amrein
(K)
Nada Andelic
(N)
Lasse Andreassen
(L)
Audny Anke
(A)
Anna Antoni
(A)
Gérard Audibert
(G)
Philippe Azouvi
(P)
Maria Luisa Azzolini
(ML)
Ronald Bartels
(R)
Pál Barzó
(P)
Romuald Beauvais
(R)
Ronny Beer
(R)
Bo-Michael Bellander
(BM)
Antonio Belli
(A)
Habib Benali
(H)
Maurizio Berardino
(M)
Luigi Beretta
(L)
Morten Blaabjerg
(M)
Peter Bragge
(P)
Alexandra Brazinova
(A)
Vibeke Brinck
(V)
Joanne Brooker
(J)
Camilla Brorsson
(C)
Andras Buki
(A)
Monika Bullinger
(M)
Manuel Cabeleira
(M)
Alessio Caccioppola
(A)
Emiliana Calappi
(E)
Maria Rosa Calvi
(MR)
Peter Cameron
(P)
Guillermo Carbayo Lozano
(GC)
Marco Carbonara
(M)
Simona Cavallo
(S)
Giorgio Chevallard
(G)
Arturo Chieregato
(A)
Giuseppe Citerio
(G)
Iris Ceyisakar
(I)
Hans Clusmann
(H)
Mark Coburn
(M)
Jonathan Coles
(J)
Jamie D Cooper
(JD)
Marta Correia
(M)
Amra Čović
(A)
Nicola Curry
(N)
Endre Czeiter
(E)
Marek Czosnyka
(M)
Claire Dahyot-Fizelier
(C)
Paul Dark
(P)
Helen Dawes
(H)
Véronique De Keyser
(V)
Vincent Degos
(V)
Francesco Della Corte
(FD)
Hugo den Boogert
(HD)
Bart Depreitere
(B)
Đula Đilvesi
(Đ)
Abhishek Dixit
(A)
Emma Donoghue
(E)
Jens Dreier
(J)
Guy-Loup Dulière
(GL)
Ari Ercole
(A)
Patrick Esser
(P)
Erzsébet Ezer
(E)
Martin Fabricius
(M)
Valery L Feigin
(VL)
Kelly Foks
(K)
Shirin Frisvold
(S)
Alex Furmanov
(A)
Pablo Gagliardo
(P)
Damien Galanaud
(D)
Dashiell Gantner
(D)
Guoyi Gao
(G)
Pradeep George
(P)
Alexandre Ghuysen
(A)
Lelde Giga
(L)
Ben Glocker
(B)
Jagoš Golubovic
(J)
Pedro A Gomez
(PA)
Johannes Gratz
(J)
Benjamin Gravesteijn
(B)
Francesca Grossi
(F)
Russell L Gruen
(RL)
Deepak Gupta
(D)
Juanita A Haagsma
(JA)
Iain Haitsma
(I)
Raimund Helbok
(R)
Eirik Helseth
(E)
Lindsay Horton
(L)
Jilske Huijben
(J)
Peter J Hutchinson
(PJ)
Bram Jacobs
(B)
Stefan Jankowski
(S)
Mike Jarrett
(M)
Ji-Yao Jiang
(JY)
Faye Johnson
(F)
Kelly Jones
(K)
Mladen Karan
(M)
Angelos G Kolias
(AG)
Erwin Kompanje
(E)
Daniel Kondziella
(D)
Evgenios Koraropoulos
(E)
Lars-Owe Koskinen
(LO)
Noémi Kovács
(N)
Ana Kowark
(A)
Alfonso Lagares
(A)
Linda Lanyon
(L)
Steven Laureys
(S)
Fiona Lecky
(F)
Didier Ledoux
(D)
Rolf Lefering
(R)
Valerie Legrand
(V)
Aurelie Lejeune
(A)
Leon Levi
(L)
Roger Lightfoot
(R)
Hester Lingsma
(H)
Andrew I R Maas
(AIR)
Ana M Castaño-León
(AM)
Marc Maegele
(M)
Marek Majdan
(M)
Alex Manara
(A)
Geoffrey Manley
(G)
Costanza Martino
(C)
Hugues Maréchal
(H)
Julia Mattern
(J)
Catherine McMahon
(C)
Béla Melegh
(B)
David Menon
(D)
Tomas Menovsky
(T)
Ana Mikolic
(A)
Benoit Misset
(B)
Visakh Muraleedharan
(V)
Lynnette Murray
(L)
Ancuta Negru
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David Nelson
(D)
Virginia Newcombe
(V)
Daan Nieboer
(D)
József Nyirádi
(J)
Otesile Olubukola
(O)
Matej Oresic
(M)
Fabrizio Ortolano
(F)
Aarno Palotie
(A)
Paul M Parizel
(PM)
Jean-François Payen
(JF)
Natascha Perera
(N)
Vincent Perlbarg
(V)
Paolo Persona
(P)
Wilco Peul
(W)
Anna Piippo-Karjalainen
(A)
Matti Pirinen
(M)
Horia Ples
(H)
Suzanne Polinder
(S)
Inigo Pomposo
(I)
Jussi P Posti
(JP)
Louis Puybasset
(L)
Andreea Radoi
(A)
Arminas Ragauskas
(A)
Rahul Raj
(R)
Malinka Rambadagalla
(M)
Jonathan Rhodes
(J)
Sylvia Richardson
(S)
Sophie Richter
(S)
Samuli Ripatti
(S)
Saulius Rocka
(S)
Cecilie Roe
(C)
Olav Roise
(O)
Jonathan Rosand
(J)
Jeffrey V Rosenfeld
(JV)
Christina Rosenlund
(C)
Guy Rosenthal
(G)
Rolf Rossaint
(R)
Sandra Rossi
(S)
Daniel Rueckert
(D)
Martin Rusnák
(M)
Juan Sahuquillo
(J)
Oliver Sakowitz
(O)
Renan Sanchez-Porras
(R)
Janos Sandor
(J)
Nadine Schäfer
(N)
Silke Schmidt
(S)
Herbert Schoechl
(H)
Guus Schoonman
(G)
Rico Frederik Schou
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Elisabeth Schwendenwein
(E)
Charlie Sewalt
(C)
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(T)
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(MS)
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(BT)
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Marjolein Timmers
(M)
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(C)
Tony Trapani
(T)
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(CM)
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(A)
Peter Vajkoczy
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(E)
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(Z)
Mathieu van der Jagt
(M)
Gregory Van der Steen
(G)
Joukje van der Naalt
(J)
Jeroen T J M van Dijck
(JTJM)
Thomas A van Essen
(TA)
Wim Van Hecke
(W)
Caroline van Heugten
(C)
Dominique Van Praag
(D)
Thijs Vande Vyvere
(TV)
Roel P J van Wijk
(RPJ)
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(E)
Kimberley Velt
(K)
Jan Verheyden
(J)
Paul M Vespa
(PM)
Anne Vik
(A)
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(R)
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(V)
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(N)
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(D)
Petar Vulekovic
(P)
Kevin K W Wang
(KKW)
Eveline Wiegers
(E)
Guy Williams
(G)
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(L)
Stefan Winzeck
(S)
Stefan Wolf
(S)
Zhihui Yang
(Z)
Peter Ylén
(P)
Alexander Younsi
(A)
Frederick A Zeiler
(FA)
Veronika Zelinkova
(V)
Agate Ziverte
(A)
Tommaso Zoerle
(T)
Informations de copyright
© 2020. The Author(s).
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