Read by QxMD icon Read

TBI coagulopathy

Hayley L Letson, Geoffrey P Dobson
BACKGROUND: Currently no drug therapy prevents secondary injury progression after TBI. Our aim was to investigate the effects of small-volume intravenous adenosine, lidocaine and Mg (ALM) resuscitation fluid after moderate-TBI in a rat fluid-percussion injury model. METHODS: Anesthetized, mechanically-ventilated male Sprague-Dawley rats (449±5g) were randomly assigned to one of four groups: 1) Sham (craniotomy without TBI), 2) No-Treatment, 3) Saline-controls or 4) ALM therapy (all n=16)...
March 16, 2018: Journal of Trauma and Acute Care Surgery
Jianning Zhang, Fangyi Zhang, Jing-Fei Dong
Traumatic brain injury (TBI)-induced coagulopathy is a common and well-recognized risk for poor clinical outcomes, but its pathogenesis remains poorly understood and treatment options are limited and ineffective. We discuss the recent progress and knowledge gaps in understanding this lethal complication of TBI. We focus on (1) the disruption of the brain-blood barrier to disseminate brain injury systemically by releasing brain-derived molecules into the circulation and (2) TBI-induced hypercoagulable and hyperfibrinolytic states that result in persistent and delayed intracranial hemorrhage and systemic bleeding...
March 5, 2018: Blood
Ajit Sarnaik, Nikki Miller Ferguson, A M Iqbal O'Meara, Shruti Agrawal, Akash Deep, Sandra Buttram, Michael J Bell, Stephen R Wisniewski, James F Luther, Adam L Hartman, Monica S Vavilala
BACKGROUND: Although small series have suggested that younger age is associated with less favorable outcome after severe traumatic brain injury (TBI), confounders and biases have limited our understanding of this relationship. We hypothesized that there would be an association between age and mortality in children within an ongoing observational, cohort study. METHODS: The first 200 subjects from the Approaches and Decisions for Acute Pediatric TBI trial were eligible for this analysis (inclusion criteria: severe TBI (Glasgow Coma Scale [GCS] score ≤ 8], age 18 years, and intracranial pressure (ICP) monitor placed; exclusion: pregnancy)...
February 23, 2018: Neurocritical Care
Christine M Leeper, Matthew D Neal, Timothy R Billiar, Jason L Sperry, Barbara A Gaines
BACKGROUND: Elevated INR is a marker of poor outcome but not necessarily bleeding or clinical coagulopathy in injured children. Conversely, children with traumatic brain injury (TBI) tend to be hypercoagulable based on rapid thromboelastography (rTEG) parameters. Many clinicians continue to utilize INR as a treatment target. METHODS: Prospective observational study of severely-injured children age<18 with rTEG on arrival and daily thereafter for up to 7 days...
February 14, 2018: Journal of Trauma and Acute Care Surgery
Caroline Lindblad, Eric Peter Thelin, Michael Nekludov, Arvid Frostell, David W Nelson, Mikael Svensson, Bo-Michael Bellander
Background: Despite seemingly functional coagulation, hemorrhagic lesion progression is a common and devastating condition following traumatic brain injury (TBI), stressing the need for new diagnostic techniques. Multiple electrode aggregometry (MEA) measures platelet function and could aid in coagulopathy assessment following TBI. The aims of this study were to evaluate MEA temporal dynamics, influence of concomitant therapy, and its capabilities to predict lesion progression and clinical outcome in a TBI cohort...
2018: Frontiers in Neurology
Venencia Albert, Arulselvi Subramanian, Deepak Agrawal, Hara Prasad Pati, Siddhartha Datta Gupta, Asok Kumar Mukhopadhyay
STUDY DESIGN: Prospective observational cohort. OBJECTIVE: To investigate the difference in plasma levels of syndecan-1 (due to glycocalyx degradation) and soluble thrombomodulin (due to endothelial damage) in isolated severe traumatic brain injury (TBI) patients with/without early coagulopathy. A secondary objective was to compare the effects of the degree of TBI endotheliopathy on hospital mortality among patients with TBI-associated coagulopathy (TBI-AC). METHODS: Data was prospectively collected on isolated severe TBI (sTBI) patients with Glasgow Coma Scale (GCS) ≤8 less than 12 h after injury admitted to a level I trauma centre...
January 16, 2018: Medical Sciences: Open Access Journal
Grace Martin, Dhavan Shah, Nora Elson, Ryan Boudreau, Dennis Hanseman, Timothy A Pritts, Amy T Makley, Brandon Foreman, Michael D Goodman
BACKGROUND: Coagulopathy and platelet dysfunction commonly develop after traumatic brain injury (TBI). Thromboelastography (TEG) and platelet function assays (PFAs) are often performed at the time of admission; however, their roles in assessing post-TBI coagulopathy have not been investigated. We hypothesized that compared to blunt TBI, penetrating TBI would (1) demonstrate greater coagulopathy by TEG, (2) be associated with abnormal PFA results, and (3) require more blood product transfusions...
January 8, 2018: Neurocritical Care
Qiang Yuan, Jian Yu, Xing Wu, Yi-Rui Sun, Zhi-Qi Li, Zhuo-Ying Du, Xue-Hai Wu, Jin Hu
BACKGROUND: Coagulopathy is commonly observed after traumatic brain injury (TBI). However, it is not known whether using the standard independent predictors in conjunction with coagulation tests would improve their prognostic value. We determined the incidence of TBI-associated coagulopathy in patients with isolated TBI (iTBI), evaluated the prognostic value of coagulation tests for in-hospital mortality, and tested their predictive power for in-hospital mortality in patients with iTBI...
January 5, 2018: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Yuan Zhou, Wei Cai, Zilong Zhao, Tristan Hilton, Min Wang, Jason Yeon, Wei Liu, Fangyi Zhang, Fu-Dong Shi, Xiaoping Wu, Perumal Thiagarajan, Min Li, Jianning Zhang, Jing-Fei Dong
Coagulopathy is common in patients with traumatic brain injury (TBI) and predicts poor clinical outcomes. We have shown that brain-derived extracellular microvesicles, including extracellular mitochondria, play a key role in the development of TBI-induced coagulopathy. Here, we further show in mouse models that the apoptotic cell-scavenging factor lactadherin, given at a single dose of 400 µg/kg 30 min before (preconditioning) or 30 min after cerebral fluid percussion injury, prevented coagulopathy as defined by clotting time, fibrinolysis, intravascular fibrin deposition, and microvascular bleeding of the lungs...
November 21, 2017: Blood
Ryuta Nakae, Shoji Yokobori, Yasuhiro Takayama, Kentaro Kuwamoto, Yasutaka Naoe, Hiroyuki Yokota
BACKGROUND: Coagulopathy and old age have been associated with poor outcomes in traumatic brain injury (TBI) patients; however, the relationships of coagulopathy and age with the acute phase of TBI remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more severe in older patients in the acute phase of TBI and may explain, in part, their poor outcome. METHODS: We analyzed the relationship between coagulation/fibrinolytic parameters and age in the acute phase of TBI by retrospectively evaluating 274 patients with initial blood samples obtained no more than 1 hour after injury...
2017: Surgical Neurology International
Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba, Terence O'Keeffe, Martin A Schreiber, Charles E Wade, Thomas M Scalea, John B Holcomb, Deborah M Stein
BACKGROUND: Often the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes after concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI + HS) had worse outcomes and required more intensive care compared with patients with only one of these injuries...
October 2017: Journal of Trauma and Acute Care Surgery
Kazutaka Sugimoto, Eiichi Suehiro, Mizuya Shinoyama, Hirokazu Sadahiro, Kouhei Haji, Yuichi Fujiyama, Reo Kawano, Mitsuaki Nishioka, Michiyasu Suzuki
CT scans are useful in patients with traumatic brain injury (TBI), but the potential risks associated with ionizing radiation are unknown. Further, CT scans are not commonly available in developing countries. In this study, coagulopathy and abnormal fibrinolysis were investigated as blood biomarkers for detection of structural disorder in mild traumatic brain injury (TBI). A total of 88 patients with mild and isolated TBI (Glasgow Coma Scale [GCS] score 14-15) were admitted to Kenwakai Ootemachi Hospital between October 2014 and March 2016...
December 1, 2017: Journal of Neurotrauma
Julian Xinguang Han, Angela An Qi See, Mihir Gandhi, Nicolas Kon Kam King
OBJECTIVE: Current prognostic models for traumatic brain injury (TBI) are developed from diverse historical data sets. We aimed to construct a prognostication tool for patients with severe TBI, as this group would benefit most from an accurate model. METHODS: Model development was based on a cohort of 300 patients with severe TBI (Glasgow Coma Scale score ≤8) consecutively admitted to a neurosurgical intensive care unit at the National Neuroscience Institute (NNI), Singapore, between February 2006 and December 2009...
December 2017: World Neurosurgery
Lindley E Folkerson, Duncan Sloan, Elizabeth Davis, Ryan S Kitagawa, Bryan A Cotton, John B Holcomb, Jeffrey S Tomasek, Charles E Wade
STUDY HYPOTHESIS: Traumatic brain injury (TBI) is a leading cause of mortality with penetrating TBI (p-TBI) patients having worse outcomes. These patients are more likely to be coagulopathic than blunt TBI (b-TBI) patients, thus we hypothesize that coagulopathy would be an early predictor of mortality. METHODS: We identified highest-level trauma activation patients who underwent an admission head CT and had ICU admission orders from August 2009-May 2013, excluding those with polytrauma and anticoagulant use...
July 5, 2017: American Journal of Emergency Medicine
Simone E Dekker, Vahagn C Nikolian, Martin Sillesen, Ted Bambakidis, Patrick Schober, Hasan B Alam
Traumatic brain injury (TBI) is a leading cause of death in young adults, and effective treatment strategies have the potential to save many lives. TBI results in coagulopathy, endothelial dysfunction, inflammation, cell death, and impaired epigenetic homeostasis, ultimately leading to morbidity and/or mortality. Commonly used resuscitation fluids such as crystalloids or colloids have several disadvantages and might even be harmful when administered in large quantities. There is a need for next-generation treatment strategies (especially in the prehospital setting) that minimize cellular damage, improve survival, and enhance neurological recovery...
July 25, 2017: Journal of Neuroscience Research
Joseph P Herbert, Andrew R Guillotte, Richard D Hammer, N Scott Litofsky
Mild traumatic brain injury (mTBI) is a common, although poorly-defined clinical entity. Despite its initially mild presentation, patients with mTBI can rapidly deteriorate, often due to significant expansion of intracranial hemorrhage. TBI-associated coagulopathy is the topic of significant clinical and basic science research. Unlike trauma-induced coagulopathy (TIC), TBI-associated coagulopathy does not generally follow widespread injury or global hypoperfusion, suggesting a distinct pathogenesis. Although the fundamental mechanisms of TBI-associated coagulopathy are far from clearly elucidated, several candidate molecules (tissue plasminogen activator (tPA), urokinase plasminogen activator (uPA), tissue factor (TF), and brain-derived microparticles (BDMP)) have been proposed which might explain how even minor brain injury can induce local and systemic coagulopathy...
July 22, 2017: Brain Sciences
Marc Maegele, Herbert Schöchl, Tomas Menovsky, Hugues Maréchal, Niklas Marklund, Andras Buki, Simon Stanworth
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...
August 2017: Lancet Neurology
Ryan M Boudreau, Mark Johnson, Rosalie Veile, Lou Ann Friend, Holly Goetzman, Timothy A Pritts, Charles C Caldwell, Amy T Makley, Michael D Goodman
BACKGROUND: Posttraumatic coagulopathy and inflammation can exacerbate secondary cerebral damage after traumatic brain injury (TBI). Tranexamic acid (TXA) has been shown clinically to reduce mortality in hemorrhaging and head-injured trauma patients and has the potential to mitigate secondary brain injury with its reported antifibrinolytic and antiinflammatory properties. We hypothesized that TXA would improve posttraumatic coagulation and inflammation in a murine model of TBI alone and in a combined injury model of TBI and hemorrhage (TBI/H)...
July 2017: Journal of Surgical Research
Samuel M Galvagno, Erin E Fox, Savitri N Appana, Sarah Baraniuk, Patrick L Bosarge, Eileen M Bulger, Rachel A Callcut, Bryan A Cotton, Michael Goodman, Kenji Inaba, Terence O'Keeffe, Martin A Schreiber, Charles E Wade, Thomas M Scalea, John B Holcomb, Deborah M Stein
BACKGROUND: Often the clinician is faced with a diagnostic and therapeutic dilemma in patients with concomitant traumatic brain injury (TBI) and hemorrhagic shock (HS), as rapid deterioration from either can be fatal. Knowledge about outcomes following concomitant TBI and HS may help prioritize the emergent management of these patients. We hypothesized that patients with concomitant TBI and HS (TBI+HS) had worse outcomes and required more intensive care compared to patients with only one of these injuries...
June 6, 2017: Journal of Trauma and Acute Care Surgery
Matthew C Hernandez, Cornelius A Thiels, Johnathon M Aho, Elizabeth B Habermann, Martin D Zielinski, James A Stubbs, Donald H Jenkins, Scott P Zietlow
BACKGROUND: Trauma-related hypotension and coagulopathy worsen secondary brain injury in patients with traumatic brain injuries (TBIs). Early damage control resuscitation with blood products may mitigate hypotension and coagulopathy. Preliminary data suggest resuscitation with plasma in large animals improves neurologic function after TBI; however, data in humans are lacking. METHODS: We retrospectively identified all patients with multiple injuries age >15 years with head injuries undergoing prehospital resuscitation with blood products at a single Level I trauma center from January 2002 to December 2013...
September 2017: Journal of Trauma and Acute Care Surgery
Fetch more papers »
Fetching more papers... Fetching...
Read by QxMD. Sign in or create an account to discover new knowledge that matter to you.
Remove bar
Read by QxMD icon Read

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"