Harhangi B S, Kompanje E J O, Leebeek F W G, Maas A I R
Department of Neurosurgery, Erasmus MC, Rotterdam, The Netherlands.
Acta Neurochir (Wien). 2008 Feb;150(2):165-75; discussion 175. doi: 10.1007/s00701-007-1475-8. Epub 2008 Jan 2.
Over the past decade new insights in our understanding of coagulation have identified the prominent role of tissue factor. The brain is rich in tissue factor, and injury to the brain may initiate disturbances in local and systemic coagulation. We aimed to review the current knowledge on the pathophysiology, incidence, nature, prognosis and treatment of coagulation disorders following traumatic brain injury (TBI).
We performed a MEDLINE search from 1966 to April 2007 with various MESH headings, focusing on head trauma and coagulopathy. We identified 441 eligible English language studies. These were reviewed for relevance by two independent investigators. A meta-analysis was performed to calculate the frequencies of coagulopathy after TBI and to determine the association of coagulopathy and outcome, expressed as odds ratios.
Eighty-two studies were relevant for the purpose of this review. Meta-analysis of 34 studies reporting the frequencies of coagulopathy after TBI, showed an overall prevalence of 32.7%. The presence of coagulopathy after TBI was related both to mortality (OR 9.0; 95%CI: 7.3-11.6) and unfavourable outcome (OR 36.3; 95%CI: 18.7-70.5).
We conclude that coagulopathy following traumatic brain injury is an important independent risk factor related to prognosis. Routine determination of the coagulation status should therefore be performed in all patients with traumatic brain injury. These data may have important implications in patient management. Well-performed prospective clinical trials should be undertaken as a priority to determine the beneficial effects of early treatment of coagulopathy.
在过去十年中，我们对凝血的理解有了新的认识，确定了组织因子的重要作用。脑内富含组织因子，脑损伤可能引发局部和全身凝血紊乱。我们旨在综述目前关于创伤性脑损伤（TBI）后凝血障碍的病理生理学、发病率、性质、预后及治疗的知识。
我们使用各种医学主题词（MESH）在1966年至2007年4月期间进行了MEDLINE检索，重点是头部创伤和凝血病。我们确定了441项符合条件的英文研究。由两名独立研究人员对这些研究进行相关性审查。进行荟萃分析以计算TBI后凝血病的发生率，并确定凝血病与预后的关联，以比值比表示。
82项研究与本综述目的相关。对34项报告TBI后凝血病发生率的研究进行荟萃分析，结果显示总体患病率为32.7%。TBI后凝血病的存在与死亡率（比值比9.0；95%置信区间：7.3 - 11.6）和不良预后（比值比36.3；95%置信区间：18.7 - 70.5）均相关。
我们得出结论，创伤性脑损伤后的凝血病是与预后相关的重要独立危险因素。因此，应对所有创伤性脑损伤患者进行凝血状态的常规测定。这些数据可能对患者管理具有重要意义。应优先开展设计良好的前瞻性临床试验，以确定早期治疗凝血病的有益效果。
