Coagulopathy in Head Trauma – as Complicated as Ever

Many years ago, while I was a Chief Resident in my neurological surgery training program, I solicited the aid of my Department Chairman to have the Emergency Department add coagulation testing to the routine labs acquired on head trauma patients. Believe it or not, at that time, despite knowledge that coagulopathy frequently complicates traumatic brain injury (TBI), such testing was usually not performed until the neurosurgery service ordered the test. While understanding about coagulation deficits has increased over time, the problem has also become increasingly complicated by an older population, additional causes of coagulopathy (particularly in the form of new drugs), additional tests to define coagulopathy, and new (and expensive potential treatments).