Coagulation disorders in traumatic brain injury.
نویسندگان
چکیده
Dear Editor, We read with great interest the recent article by Dudley and associates on early venous thromboembolic event (VTE) prophylaxis in traumatic brain injury (TBI) with lowmolecular-weight heparin (LMWH; Dudley, 2010). In that study the authors investigated the occurrence and timing of VTE, the symptomatic expansion of intracranial hemorrhages while on VTE prophylaxis, and the efficacy of two prophylactic agents. VTE occurred in 7.3% of patients. No significant difference in VTE occurrence between the two prophylactic agents was noted. Expansion of intracranial hemorrhage was noted in one patient. The authors concluded that VTE prophylaxis provides adequate protection, and that the risk of intracranial hemorrhage expansion is extremely low (Dudley, 2010). Coagulopathy is frequently encountered in patients following TBI. Regional and systemic hypercoagulability and increased d-dimer concentrations are common (Scherer and Spangenberg, 1998). This can result in the creation of microthrombi in all parts of the vascular compartment that may produce secondary injury (Hess and Lawson, 2006). The occurrence of coagulopathy in TBI has been considered a manifestation of disseminated intravascular coagulation (DIC). The use of LMWH is recommended for the treatment of even asymptomatic DIC (Wada et al., 2010), and thus LMWH may have a role in the outcome of patients with TBI. Recently, we have prospectively evaluated the safety of early administration of LMWH at a prophylactic dose in 61 patients with moderate TBI. We found that 69% of these patients had on admission subclinical compensated activation of hemostatic factors. The presence of coagulopathy was defined based on prothrombin time and plasma fibrinogen and d-dimer levels. The Glasgow Coma Scale (GCS) score at admission was significantly correlated with coagulopathy occurrence. Following LMWH administration, no clinical manifestations of DIC or LMWH-related side effects was found. The hemorrhagic lesions that were initially detected on computed tomography did not increase in size (Pahatouridis et al., 2010). We believe that aside from VTE prophylaxis, LMWH may play an additional role in patients with TBI. There is a clear need for further prospective studies to clarify the role of LMWH in coagulopathy and patient outcomes after TBI.
منابع مشابه
Identification of Imaging and Clinical Markers Predicting Chronic Sleep Disturbances After Traumatic Brain Injury in Adults
Background and Aim: We aimed to determine the prognostic imaging and clinical markers of chronic Post-Traumatic Sleep-Wake Disorders (PTSWDs) with a special focus on the early cognitive and executive dysfunctions following Traumatic Brain Injury (TBI). The prevalence rate of Post-Traumatic Psychiatric Disorders (PTPDs) in various sleep disorders was also investigated. Methods and Materials/Pat...
متن کاملApplication of Magnetic Resonance Spectroscopy in Neurocognitive Assessment After Head Injury: A Systematic Review
Background: Traumatic brain injury is believed to be a public health disorder with some complications. Post Traumatic Neurocognitive Disorders (PTND) received much attention among these complications because of the high prevalence of mild traumatic brain injuries. On the other hand, advanced neuroimaging is increasingly becoming an exciting modality in the field of traumatic brain injury. Magne...
متن کاملNeuropsychological and Neuropsychiatric Deficits Following Traumatic Brain Injury: Common Patterns and Neuropathological Mechanisms
Traumatic Brain Injury (TBI) in all degrees of injury severity mainly induces deviant cognitive, emotional and behavioral alterations that lead to their respective disorders. This brief overview strives to define the variables that determine the risk of occurrence of these disorders and to describe the common patterns of these disorders and their relevant neuropathogenetic mechanism(s). In addi...
متن کاملPrediction of mental disorders after Mild Traumatic Brain Injury: principle component Approach
Introduction: In Processes Modeling, when there is relatively a high correlation between covariates, multicollinearity is created, and it leads to reduction in model's efficiency. In this study, by using principle component analysis, modification of the effect of multicolinearity in Artificial Neural Network (ANN) and Logistic Regression (LR) has been studied. Also, the effect of multicolineari...
متن کاملThe coagulation system: a vulnerable system and a potential therapeutic aimpoint in treatment of traumatic brain injury.
متن کامل
P143: The Neuroprotective Effect of Chloroquine in Animal Model of Traumatic Brain Injury
Traumatic brain injury (TBI) is one of the leading causes of morbidity and mortality in young adults and children, and is a leading public health problem worldwide. In TBI, neurological impairment is caused by immediate brain tissue disruption (primary injury) and post‑injury cellular and molecular events (secondary injury) that exacerbate the primary neurological insult. However, the destructi...
متن کاملذخیره در منابع من
با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید
عنوان ژورنال:
- Journal of neurotrauma
دوره 28 4 شماره
صفحات -
تاریخ انتشار 2011