Kockelmann Fabian, Maegele Marc
Department of Surgery, Klinikum Dortmund, University Hospital of the University Witten/Herdecke, Beurhausstr. 40, D-44137 Dortmund, Germany.
Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Campus Cologne-Merheim, Ostmerheimerstr. 200, D-51109 Köln, Germany.
J Clin Med. 2023 Apr 11;12(8):2809. doi: 10.3390/jcm12082809.
Because of the aging population, the number of low falls in elderly people with pre-existing anticoagulation is rising, often leading to traumatic brain injury (TBI) with a social and economic burden. Hemostatic disorders and disbalances seem to play a pivotal role in bleeding progression. Interrelationships between anticoagulatoric medication, coagulopathy, and bleeding progression seem to be a promising aim of therapy.
We conducted a selective search of the literature in databases like Medline (Pubmed), Cochrane Library and current European treatment recommendations using relevant terms or their combination.
Patients with isolated TBI are at risk for developing coagulopathy in the clinical course. Pre-injury intake of anticoagulants is leading to a significant increase in coagulopathy, so every third patient with TBI in this population suffers from coagulopathy, leading to hemorrhagic progression and delayed traumatic intracranial hemorrhage. In an assessment of coagulopathy, viscoelastic tests such as TEG or ROTEM seem to be more beneficial than conventional coagulation assays alone, especially because of their timely and more specific gain of information about coagulopathy. Furthermore, results of point-of-care diagnostic make rapid "goal-directed therapy" possible with promising results in subgroups of patients with TBI.
The use of innovative technologies such as viscoelastic tests in the assessment of hemostatic disorders and implementation of treatment algorithms seem to be beneficial in patients with TBI, but further studies are needed to evaluate their impact on secondary brain injury and mortality.
由于人口老龄化，患有基础抗凝治疗的老年人中轻度跌倒的数量正在上升，这常常导致创伤性脑损伤（TBI），带来社会和经济负担。止血障碍和失衡似乎在出血进展中起关键作用。抗凝药物、凝血病和出血进展之间的相互关系似乎是一个有前景的治疗目标。
我们在Medline（PubMed）、Cochrane图书馆等数据库以及当前欧洲治疗指南中使用相关术语或其组合进行了文献的选择性检索。
孤立性TBI患者在临床过程中有发生凝血病的风险。受伤前服用抗凝剂会导致凝血病显著增加，因此该人群中每三名TBI患者就有一名患有凝血病，导致出血进展和延迟性创伤性颅内出血。在评估凝血病时，诸如血栓弹力图（TEG）或旋转血栓弹力测定（ROTEM）等黏弹性试验似乎比单纯的传统凝血试验更有益，特别是因为它们能及时且更具体地获取有关凝血病的信息。此外，即时检验诊断结果使快速“目标导向治疗”成为可能，在TBI患者亚组中取得了有前景的结果。
在评估止血障碍时使用诸如黏弹性试验等创新技术以及实施治疗算法似乎对TBI患者有益，但需要进一步研究来评估它们对继发性脑损伤和死亡率的影响。
