Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Bohm, J.K.; Guting, H.; Thorn, S.; Schafer, N.; Rambach, V.; Schochl, H.; Grottke, O.; Rossaint, R.; Stanworth, S.; Curry, N.; Lefering, R.; Maegele, M.; Akerlund, C.; Amrein, K.; Andelic, N.; Andreassen, L.; Anke, A.; Antoni, A.; Audibert, G.; Azouvi, P.; Azzolini, M.L.; Bartels, R.; Barzo, P.; Beauvais, R.; Beer, R.; Bellander, B.; Belli, A.; Benali, H.; Berardino, M.; Beretta, L.; Blaabjerg, M.; Bragge, P.; Brazinova, A.; Brinck, V.; Brooker, J.; Brorsson, C.; Buki, A.; Bullinger, M.; Cabeleira, M.; Caccioppola, A.; Calappi, E.; Calvi, M.R.; Cameron, P.; Lozano, G.C.; Carbonara, M.; Cavallo, S.; Chevallard, G.; Chieregato, A.; Citerio, G.; Ceyisakar, I.; Clusmann, H.; Coburn, M.; Coles, J.; Cooper, J.; Correia, M.; Covic, A.; Curry, N.; Czeiter, E.; Czosnyka, M.; Dahyot-Fizelier, C.; Dark, P.; Dawes, H.; Keyser, V.; Degos, V.; Corte, F.D.; Boogert, H.D.; Depreitere, B.; Dilvesi, B.; Dixit, A.; Donoghue, E.; Dreier, J.; Duliere, G.; Ercole, A.; Esser, P.; Ezer, E.; Fabricius, M.; Feigin, V.; Foks, K.; Frisvold, S.; Furmanov, A.; Gagliardo, P.; Galanaud, D.; Gantner, D.; Gao, G.; George, P.; Ghuysen, A.; Giga, L.; Glocker, B.; Golubovic, J.; Gomez, P.; Gratz, J.; Gravesteijn, B.; Grossi, F.; Gruen, R.; Gupta, D.; Haagsma, J.; Haitsma, I.; Helbok, R.; Helseth, E.; Horton, L.; Huijben, J.; Hutchinson, P.; Jacobs, B.; Jankowski, S.; Jarrett, M.; Jiang, J.; Johnson, F.; Jones, K.; Karan, M.; Kolias, A.; Kompanje, E.; Kondziella, D.; Koraropoulos, E.; Koskinen, L.; Kovacs, N.; Kowark, A.; Lagares, A.; Lanyon, L.; Laureys, S.; Lecky, F.; Ledoux, D.; Legrand, V.; Lejeune, A.; Levi, L.; Lightfoot, R.; Lingsma, H.; Maas, A.; M. Castano-Leon A.,; Maegele, M.; Majdan, M.; Manara, A.; Manley, G.; Martino, C.; Marechal, H.; Mattern, J.; Mcmahon, C.; Melegh, B.; Menon, D.; Menovsky, T.; Mikolic, A.; Misset, B.; Muraleedharan, V.; Murray, L.; Negru, A.; Nelson, D.; Newcombe, V.; Nieboer, D.; Nyiradi, J.; Olubukola, O.; Oresic, M.; Ortolano, F.; Palotie, A.; Parizel, P.; Payen, J.; Perera, N.; Perlbarg, V.; Persona, P.; Peul, W.; Piippo-Karjalainen, A.; Pirinen, M.; Ples, H.; Polinder, S.; Pomposo, I.; Posti, J.; Puybasset, L.; Radoi, A.; Ragauskas, A.; Raj, R.; Rambadagalla, M.; Rhodes, J.; Richardson, S.; Richter, S.; Ripatti, S.; Rocka, S.; Roe, C.; Roise, O.; Rosand, J.; Rosenfeld, J.; Rosenlund, C.; Rosenthal, G.; Rossi, S.; Rueckert, D.; Rusnak, M.; Sahuquillo, J.; Sakowitz, O.; Sanchez-Porras, R.; Sandor, J.; Schafer, N.; Schmidt, S.; Schoechl, H.; Schoonman, G.; Schou, R.F.; Schwendenwein, E.; Sewalt, C.; Skandsen, T.; Smielewski, P.; Sorinola, A.; Stamatakis, E.; Stevens, R.; Stewart, W.; Steyerberg, E.; Stocchetti, N.; Sundstrom, N.; Synnot, A.; Takala, R.; Tamas, V.; Tamosuitis, T.; Taylor, M.S.; B. T., A.; Tenovuo, O.; Theadom, A.; Thomas, M.; Tibboel, D.; Timmers, M.; Tolias, C.; Trapani, T.; Tudora, C.M.; Unterberg, A.; Vajkoczy, P.; Vallance, S.; Valeinis, E.; Vamos, Z.; Jagt, M.; Steen, G.; Naalt, J.; Dijck, J.; Essen, T.; Hecke, W.V.; Heugten, C.V.; Praag, D.V.; Vyvere, T.V.; Wijk, R.; Vargiolu, A.; Vega, E.; Velt, K.; Verheyden, J.; Vespa, P.; Vik, A.; Vilcinis, R.; Volovici, V.; Von Steinbuchel, N.; Voormolen, D.; Vulekovic, P.; Wang, K.; Wiegers, E.; Williams, G.; Wilson, L.; Winzeck, S.; Wolf, S.; Yang, Z.; Ylen, P.; Younsi, A.; Zeiler, F.; Zelinkova, V.; Ziverte, A.; Zoerle, T.

doi:10.1007/s12028-020-01151-7

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.

Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis / J.K. Bohm, H. Guting, S. Thorn, N. Schafer, V. Rambach, H. Schochl, O. Grottke, R. Rossaint, S. Stanworth, N. Curry, R. Lefering, M. Maegele, C. Akerlund, K. Amrein, N. Andelic, L. Andreassen, A. Anke, A. Antoni, G. Audibert, P. Azouvi, M.L. Azzolini, R. Bartels, P. Barzo, R. Beauvais, R. Beer, B. Bellander, A. Belli, H. Benali, M. Berardino, L. Beretta, M. Blaabjerg, P. Bragge, A. Brazinova, V. Brinck, J. Brooker, C. Brorsson, A. Buki, M. Bullinger, M. Cabeleira, A. Caccioppola, E. Calappi, M.R. Calvi, P. Cameron, G.C. Lozano, M. Carbonara, S. Cavallo, G. Chevallard, A. Chieregato, G. Citerio, I. Ceyisakar, H. Clusmann, M. Coburn, J. Coles, J. Cooper, M. Correia, A. Covic, N. Curry, E. Czeiter, M. Czosnyka, C. Dahyot-Fizelier, P. Dark, H. Dawes, V. Keyser, V. Degos, F.D. Corte, H.D. Boogert, B. Depreitere, B. Dilvesi, A. Dixit, E. Donoghue, J. Dreier, G. Duliere, A. Ercole, P. Esser, E. Ezer, M. Fabricius, V. Feigin, K. Foks, S. Frisvold, A. Furmanov, P. Gagliardo, D. Galanaud, D. Gantner, G. Gao, P. George, A. Ghuysen, L. Giga, B. Glocker, J. Golubovic, P. Gomez, J. Gratz, B. Gravesteijn, F. Grossi, R. Gruen, D. Gupta, J. Haagsma, I. Haitsma, R. Helbok, E. Helseth, L. Horton, J. Huijben, P. Hutchinson, B. Jacobs, S. Jankowski, M. Jarrett, J. Jiang, F. Johnson, K. Jones, M. Karan, A. Kolias, E. Kompanje, D. Kondziella, E. Koraropoulos, L. Koskinen, N. Kovacs, A. Kowark, A. Lagares, L. Lanyon, S. Laureys, F. Lecky, D. Ledoux, V. Legrand, A. Lejeune, L. Levi, R. Lightfoot, H. Lingsma, A. Maas, A. M. Castano-Leon, M. Maegele, M. Majdan, A. Manara, G. Manley, C. Martino, H. Marechal, J. Mattern, C. Mcmahon, B. Melegh, D. Menon, T. Menovsky, A. Mikolic, B. Misset, V. Muraleedharan, L. Murray, A. Negru, D. Nelson, V. Newcombe, D. Nieboer, J. Nyiradi, O. Olubukola, M. Oresic, F. Ortolano, A. Palotie, P. Parizel, J. Payen, N. Perera, V. Perlbarg, P. Persona, W. Peul, A. Piippo-Karjalainen, M. Pirinen, H. Ples, S. Polinder, I. Pomposo, J. Posti, L. Puybasset, A. Radoi, A. Ragauskas, R. Raj, M. Rambadagalla, J. Rhodes, S. Richardson, S. Richter, S. Ripatti, S. Rocka, C. Roe, O. Roise, J. Rosand, J. Rosenfeld, C. Rosenlund, G. Rosenthal, S. Rossi, D. Rueckert, M. Rusnak, J. Sahuquillo, O. Sakowitz, R. Sanchez-Porras, J. Sandor, N. Schafer, S. Schmidt, H. Schoechl, G. Schoonman, R.F. Schou, E. Schwendenwein, C. Sewalt, T. Skandsen, P. Smielewski, A. Sorinola, E. Stamatakis, R. Stevens, W. Stewart, E. Steyerberg, N. Stocchetti, N. Sundstrom, A. Synnot, R. Takala, V. Tamas, T. Tamosuitis, M.S. Taylor, B.T. Ao, O. Tenovuo, A. Theadom, M. Thomas, D. Tibboel, M. Timmers, C. Tolias, T. Trapani, C.M. Tudora, A. Unterberg, P. Vajkoczy, S. Vallance, E. Valeinis, Z. Vamos, M. Jagt, G. Steen, J. Naalt, J. Dijck, T. Essen, W.V. Hecke, C.V. Heugten, D.V. Praag, T.V. Vyvere, R. Wijk, A. Vargiolu, E. Vega, K. Velt, J. Verheyden, P. Vespa, A. Vik, R. Vilcinis, V. Volovici, N. Von Steinbuchel, D. Voormolen, P. Vulekovic, K. Wang, E. Wiegers, G. Williams, L. Wilson, S. Winzeck, S. Wolf, Z. Yang, P. Ylen, A. Younsi, F. Zeiler, V. Zelinkova, A. Ziverte, T. Zoerle. - In: NEUROCRITICAL CARE. - ISSN 1541-6933. - 35:1(2021 Jan), pp. 184-196. [10.1007/s12028-020-01151-7]

Global Characterisation of Coagulopathy in Isolated Traumatic Brain Injury (iTBI): A CENTER-TBI Analysis

Bohm J. K.;Guting H.;Thorn S.;Schafer N.;Rambach V.;Schochl H.;Grottke O.;Rossaint R.;Stanworth S.;Curry N.;Lefering R.;Maegele M.;Akerlund C.;Amrein K.;Andelic N.;Andreassen L.;Anke A.;Antoni A.;Audibert G.;Azouvi P.;Azzolini M. L.;Bartels R.;Barzo P.;Beauvais R.;Beer R.;Bellander B.;Belli A.;Benali H.;Berardino M.;Beretta L.;Blaabjerg M.;Bragge P.;Brazinova A.;Brinck V.;Brooker J.;Brorsson C.;Buki A.;Bullinger M.;Cabeleira M.;A. Caccioppola;Calappi E.;Calvi M. R.;Cameron P.;Lozano G. C.;Carbonara M.;Cavallo S.;G. Chevallard;Chieregato A.;Citerio G.;Ceyisakar I.;Clusmann H.;Coburn M.;Coles J.;Cooper J.;Correia M.;Covic A.;Curry N.;Czeiter E.;Czosnyka M.;Dahyot-Fizelier C.;Dark P.;Dawes H.;Keyser V.;Degos V.;Corte F. D.;Boogert H. d.;Depreitere B.;Dilvesi B.;Dixit A.;Donoghue E.;Dreier J.;Duliere G.;Ercole A.;Esser P.;Ezer E.;Fabricius M.;Feigin V.;Foks K.;Frisvold S.;Furmanov A.;Gagliardo P.;Galanaud D.;Gantner D.;Gao G.;George P.;Ghuysen A.;Giga L.;Glocker B.;Golubovic J.;Gomez P.;Gratz J.;Gravesteijn B.;Grossi F.;Gruen R.;Gupta D.;Haagsma J.;Haitsma I.;Helbok R.;Helseth E.;Horton L.;Huijben J.;Hutchinson P.;Jacobs B.;Jankowski S.;Jarrett M.;Jiang J.;Johnson F.;Jones K.;Karan M.;Kolias A.;Kompanje E.;Kondziella D.;Koraropoulos E.;Koskinen L.;Kovacs N.;Kowark A.;Lagares A.;Lanyon L.;Laureys S.;Lecky F.;Ledoux D.;Legrand V.;Lejeune A.;Levi L.;Lightfoot R.;Lingsma H.;Maas A.;M. Castano-Leon A.;Maegele M.;Majdan M.;Manara A.;Manley G.;Martino C.;Marechal H.;Mattern J.;McMahon C.;Melegh B.;Menon D.;Menovsky T.;Mikolic A.;Misset B.;Muraleedharan V.;Murray L.;Negru A.;Nelson D.;Newcombe V.;Nieboer D.;Nyiradi J.;Olubukola O.;Oresic M.;F. Ortolano;Palotie A.;Parizel P.;Payen J.;Perera N.;Perlbarg V.;Persona P.;Peul W.;Piippo-Karjalainen A.;Pirinen M.;Ples H.;Polinder S.;Pomposo I.;Posti J.;Puybasset L.;Radoi A.;Ragauskas A.;Raj R.;Rambadagalla M.;Rhodes J.;Richardson S.;Richter S.;Ripatti S.;Rocka S.;Roe C.;Roise O.;Rosand J.;Rosenfeld J.;Rosenlund C.;Rosenthal G.;Rossi S.;Rueckert D.;Rusnak M.;Sahuquillo J.;Sakowitz O.;Sanchez-Porras R.;Sandor J.;Schafer N.;Schmidt S.;Schoechl H.;Schoonman G.;Schou R. F.;Schwendenwein E.;Sewalt C.;Skandsen T.;Smielewski P.;Sorinola A.;Stamatakis E.;Stevens R.;Stewart W.;Steyerberg E.;N. Stocchetti;Sundstrom N.;Synnot A.;Takala R.;Tamas V.;Tamosuitis T.;Taylor M. S.;Ao B. T.;Tenovuo O.;Theadom A.;Thomas M.;Tibboel D.;Timmers M.;Tolias C.;Trapani T.;Tudora C. M.;Unterberg A.;Vajkoczy P.;Vallance S.;Valeinis E.;Vamos Z.;Jagt M.;Steen G.;Naalt J.;Dijck J.;Essen T.;Hecke W. V.;Heugten C. v.;Praag D. V.;Vyvere T. V.;Wijk R.;Vargiolu A.;Vega E.;Velt K.;Verheyden J.;Vespa P.;Vik A.;Vilcinis R.;Volovici V.;von Steinbuchel N.;Voormolen D.;Vulekovic P.;Wang K.;Wiegers E.;Williams G.;Wilson L.;Winzeck S.;Wolf S.;Yang Z.;Ylen P.;Younsi A.;Zeiler F.;Zelinkova V.;Ziverte A.;T. Zoerle

2021

Abstract

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.

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	Parole chiave
	
				CENTER-TBI; Coagulopathy; Risk factors; Traumatic brain injury
			
	Settori scientifico-disciplinari dell'articolo (validi dal 09/05/2024)
	
				Settore MEDS-23/A - Anestesiologia
			
	Data di pubblicazione
	
				gen-2021
			
	Rivista in ANCE
	
				NEUROCRITICAL CARE
			
	DOI
	
				https://dx.doi.org/10.1007/s12028-020-01151-7
			
	Tipologia
	
				Article (author)
			
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				01 - Articolo su periodico

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