Gozal Yair M, Carroll Christopher P, Krueger Bryan M, Khoury Jane, Andaluz Norberto O
Department of Neurosurgery, University of Cincinnati (UC) College of Medicine, Cincinnati, Ohio, USA.
Neurotrauma Center, UC Neuroscience Institute, Cincinnati, Ohio, USA.
Surg Neurol Int. 2017 Apr 5;8:48. doi: 10.4103/sni.sni_265_16. eCollection 2017.
The use of anticoagulants or antiplatelet medications has become increasingly common and is a well-established risk factor for worsening of hemorrhages in trauma patients. The current study addresses the need to investigate the efficacy of point-of-care tests (POC) as an adjunct to conventional coagulation testing in traumatic brain injury (TBI) patients.
A retrospective review of 190 TBI patients >18 years of age who underwent both conventional and POC testing as part of their admission coagulopathy workup was conducted. Coagulation deficiency was defined as an international normalized ratio (INR) >1.4, a reaction time (r-value) on rapid thromboelastography >50 seconds, or a VerifyNow Aspirin (VN-ASA) level of < 550 Aspirin Reaction Units.
Among 190 patients, 91 (48%) disclosed a history of either warfarin or antiplatelet use or had documented INR >1.4. Of the 18 (9%) patients who reported warfarin use, 83% had elevated INR and 61% had elevated r-value. However, 41% of the patients without reported anticoagulant usage revealed significantly elevated r-value consistent with a post-traumatic hypocoagulable state. Of 64 (34%) patients who reported taking ASA, 51 (80%) demonstrated therapeutic VN-ASA. Interestingly, 31 of 126 (25%) patients not reporting ASA use were also noted to have therapeutic VN-ASA suggestive of platelet dysfunction.
The coagulopathy POC panel consisting of r-TEG and VN-ASA successfully identified a subset of TBI patients with an occult coagulopathy that would have otherwise been missed. Standardization of these POC assays on admission in TBI may help guide patient resuscitation in the acute setting.
抗凝剂或抗血小板药物的使用越来越普遍，并且是创伤患者出血恶化的一个公认风险因素。本研究旨在探讨即时检验（POC）作为创伤性脑损伤（TBI）患者传统凝血检测辅助手段的有效性。
对190例年龄大于18岁的TBI患者进行回顾性研究，这些患者在入院时进行了凝血功能障碍检查，包括传统检测和POC检测。凝血功能缺陷定义为国际标准化比值（INR）>1.4、快速血栓弹力图的反应时间（r值）>50秒或VerifyNow阿司匹林（VN-ASA）水平<550阿司匹林反应单位。
190例患者中，91例（48%）有华法林或抗血小板药物使用史或记录的INR>1.4。在报告使用华法林的18例（9%）患者中，83%的患者INR升高，61%的患者r值升高。然而，41%未报告使用抗凝剂的患者r值显著升高，符合创伤后低凝状态。在报告服用阿司匹林的64例（34%）患者中，51例（80%）的VN-ASA处于治疗水平。有趣的是，在126例未报告使用阿司匹林的患者中，有31例（25%）的VN-ASA也处于治疗水平，提示存在血小板功能障碍。
由r-TEG和VN-ASA组成的凝血功能障碍POC检测组成功识别出一部分隐匿性凝血功能障碍的TBI患者，否则这些患者可能会被漏诊。TBI患者入院时这些POC检测的标准化可能有助于在急性情况下指导患者的复苏治疗。
