Advanced

Coagulopathy and haemorrhagic progression in traumatic brain injury : advances in mechanisms, diagnosis, and management

Maegele, Marc; Schöchl, Herbert; Menovsky, Tomas; Maréchal, Hugues; Marklund, Niklas LU ; Buki, Andras and Stanworth, Simon (2017) In The Lancet Neurology 16(8). p.630-647
Abstract

Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality. Further blood testing often reveals a range of changes affecting platelet numbers and function, procoagulant or anticoagulant factors, fibrinolysis, and... (More)

Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality. Further blood testing often reveals a range of changes affecting platelet numbers and function, procoagulant or anticoagulant factors, fibrinolysis, and interactions between the coagulation system and the vascular endothelium, brain tissue, inflammatory mechanisms, and blood flow dynamics. However, the degree to which these coagulation abnormalities affect TBI outcomes and whether they are modifiable risk factors are not known. Although the main challenge for management is to address the risk of hypocoagulopathy with prolonged bleeding and progression of haemorrhagic lesions, the risk of hypercoagulopathy with an increased prothrombotic tendency also warrants consideration.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
The Lancet Neurology
volume
16
issue
8
pages
18 pages
publisher
Lancet Ltd
external identifiers
  • scopus:85023179398
ISSN
1474-4422
DOI
10.1016/S1474-4422(17)30197-7
language
English
LU publication?
yes
id
a25d6fee-eded-45ec-a8c3-b914a3f954bc
date added to LUP
2017-08-01 11:45:30
date last changed
2017-08-15 10:23:14
@article{a25d6fee-eded-45ec-a8c3-b914a3f954bc,
  abstract     = {<p>Normal haemostasis depends on an intricate balance between mechanisms of bleeding and mechanisms of thrombosis, and this balance can be altered after traumatic brain injury (TBI). Impaired haemostasis could exacerbate the primary insult with risk of initiation or aggravation of bleeding; anticoagulant use at the time of injury can also contribute to bleeding risk after TBI. Many patients with TBI have abnormalities on conventional coagulation tests at admission to the emergency department, and the presence of coagulopathy is associated with increased morbidity and mortality. Further blood testing often reveals a range of changes affecting platelet numbers and function, procoagulant or anticoagulant factors, fibrinolysis, and interactions between the coagulation system and the vascular endothelium, brain tissue, inflammatory mechanisms, and blood flow dynamics. However, the degree to which these coagulation abnormalities affect TBI outcomes and whether they are modifiable risk factors are not known. Although the main challenge for management is to address the risk of hypocoagulopathy with prolonged bleeding and progression of haemorrhagic lesions, the risk of hypercoagulopathy with an increased prothrombotic tendency also warrants consideration.</p>},
  author       = {Maegele, Marc and Schöchl, Herbert and Menovsky, Tomas and Maréchal, Hugues and Marklund, Niklas and Buki, Andras and Stanworth, Simon},
  issn         = {1474-4422},
  language     = {eng},
  month        = {08},
  number       = {8},
  pages        = {630--647},
  publisher    = {Lancet Ltd},
  series       = {The Lancet Neurology},
  title        = {Coagulopathy and haemorrhagic progression in traumatic brain injury : advances in mechanisms, diagnosis, and management},
  url          = {http://dx.doi.org/10.1016/S1474-4422(17)30197-7},
  volume       = {16},
  year         = {2017},
}