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Association of the bleeding time test with aspects of traumatic brain injury in patients with alcohol use disorder

Tsitsopoulos, P. P. ; Marklund, N. LU ; Rostami, E. ; Enblad, P. and Hillered, L. (2020) In Acta Neurochirurgica 162(7). p.1597-1606
Abstract

Background—aim: Traumatic brain injury (TBI) and alcohol use disorder (AUD) can occur concomitantly and be associated with coagulopathy that influences TBI outcome. The use of bleeding time tests in TBI management is controversial. We hypothesized that in TBI patients with AUD, a prolonged bleeding time is associated with more severe injury and poor outcome. Material and methods: Moderate and severe TBI patients with evidence of AUD were examined with bleeding time according to IVY bleeding time on admission during neurointensive care. Baseline clinical and radiological characteristics were recorded. A standardized IVY bleeding time test was determined by staff trained in the procedure. Bleeding time test results were divided into... (More)

Background—aim: Traumatic brain injury (TBI) and alcohol use disorder (AUD) can occur concomitantly and be associated with coagulopathy that influences TBI outcome. The use of bleeding time tests in TBI management is controversial. We hypothesized that in TBI patients with AUD, a prolonged bleeding time is associated with more severe injury and poor outcome. Material and methods: Moderate and severe TBI patients with evidence of AUD were examined with bleeding time according to IVY bleeding time on admission during neurointensive care. Baseline clinical and radiological characteristics were recorded. A standardized IVY bleeding time test was determined by staff trained in the procedure. Bleeding time test results were divided into normal (≤ 600 s), prolonged (> 600 s), and markedly prolonged (≥ 900 s). Normal platelet count (PLT) was defined as > 150,000/μL. This cohort was compared with another group of TBI patients without evidence of AUD. Results: Fifty-two patients with TBI and AUD were identified, and 121 TBI patients without any history of AUD were used as controls. PLT was low in 44.2% and bleeding time was prolonged in 69.2% of patients. Bleeding time values negatively correlated with PLT (p < 0.05). TBI patients with markedly prolonged values (≥ 900 s) had significantly increased hematoma size, and more frequently required intracranial pressure measurement and mechanical ventilation compared with those with bleeding times < 900 s (p < 0.05). Most patients (88%) with low platelet count had prolonged bleeding time. No difference in 6-month outcome between the bleeding time groups was observed (p > 0.05). Subjects with TBI and no evidence for AUD had lower bleeding time values and higher platelet count compared with those with TBI and history of AUD (p < 0.05). Conclusions: Although differences in the bleeding time values between TBI cohorts exist and prolonged values may be seen even in patients with normal platelet count, the bleeding test is a marker of primary hemostasis and platelet function with low specificity. However, it may provide an additional assessment in the interpretation of the overall status of TBI patients with AUD. Therefore, the bleeding time test should only be used in combination with the patient’s bleeding history and careful assessment of other hematologic parameters.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alcohol use disorder, Hemostasis, Injury severity, IVY bleeding time test, Outcome, Platelets, Traumatic brain injury
in
Acta Neurochirurgica
volume
162
issue
7
pages
10 pages
publisher
Springer
external identifiers
  • pmid:32425195
  • scopus:85085347111
ISSN
0001-6268
DOI
10.1007/s00701-020-04373-y
language
English
LU publication?
yes
id
32b08b1a-2846-404a-8c9b-00eff8b3b4f4
date added to LUP
2020-06-26 09:26:39
date last changed
2020-06-27 01:58:33
@article{32b08b1a-2846-404a-8c9b-00eff8b3b4f4,
  abstract     = {<p>Background—aim: Traumatic brain injury (TBI) and alcohol use disorder (AUD) can occur concomitantly and be associated with coagulopathy that influences TBI outcome. The use of bleeding time tests in TBI management is controversial. We hypothesized that in TBI patients with AUD, a prolonged bleeding time is associated with more severe injury and poor outcome. Material and methods: Moderate and severe TBI patients with evidence of AUD were examined with bleeding time according to IVY bleeding time on admission during neurointensive care. Baseline clinical and radiological characteristics were recorded. A standardized IVY bleeding time test was determined by staff trained in the procedure. Bleeding time test results were divided into normal (≤ 600 s), prolonged (&gt; 600 s), and markedly prolonged (≥ 900 s). Normal platelet count (PLT) was defined as &gt; 150,000/μL. This cohort was compared with another group of TBI patients without evidence of AUD. Results: Fifty-two patients with TBI and AUD were identified, and 121 TBI patients without any history of AUD were used as controls. PLT was low in 44.2% and bleeding time was prolonged in 69.2% of patients. Bleeding time values negatively correlated with PLT (p &lt; 0.05). TBI patients with markedly prolonged values (≥ 900 s) had significantly increased hematoma size, and more frequently required intracranial pressure measurement and mechanical ventilation compared with those with bleeding times &lt; 900 s (p &lt; 0.05). Most patients (88%) with low platelet count had prolonged bleeding time. No difference in 6-month outcome between the bleeding time groups was observed (p &gt; 0.05). Subjects with TBI and no evidence for AUD had lower bleeding time values and higher platelet count compared with those with TBI and history of AUD (p &lt; 0.05). Conclusions: Although differences in the bleeding time values between TBI cohorts exist and prolonged values may be seen even in patients with normal platelet count, the bleeding test is a marker of primary hemostasis and platelet function with low specificity. However, it may provide an additional assessment in the interpretation of the overall status of TBI patients with AUD. Therefore, the bleeding time test should only be used in combination with the patient’s bleeding history and careful assessment of other hematologic parameters.</p>},
  author       = {Tsitsopoulos, P. P. and Marklund, N. and Rostami, E. and Enblad, P. and Hillered, L.},
  issn         = {0001-6268},
  language     = {eng},
  number       = {7},
  pages        = {1597--1606},
  publisher    = {Springer},
  series       = {Acta Neurochirurgica},
  title        = {Association of the bleeding time test with aspects of traumatic brain injury in patients with alcohol use disorder},
  url          = {http://dx.doi.org/10.1007/s00701-020-04373-y},
  doi          = {10.1007/s00701-020-04373-y},
  volume       = {162},
  year         = {2020},
}