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LIBRIS Formathandbok  (Information om MARC21)
FältnamnIndikatorerMetadata
00005632naa a2200613 4500
001oai:DiVA.org:umu-215816
003SwePub
008231026s2022 | |||||||||||000 ||eng|
009oai:prod.swepub.kib.ki.se:148373349
0247 a https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-2158162 URI
0247 a https://doi.org/10.1007/s12028-021-01400-32 DOI
0247 a http://kipublications.ki.se/Default.aspx?queryparsed=id:1483733492 URI
040 a (SwePub)umud (SwePub)ki
041 a engb eng
042 9 SwePub
072 7a ref2 swepub-contenttype
072 7a art2 swepub-publicationtype
1001 a Böhm, Julia K.4 aut
2451 0a Extended Coagulation Profiling in Isolated Traumatic Brain Injury :b A CENTER-TBI Analysis
264 c 2021-12-16
264 1b Springer,c 2022
338 a electronic2 rdacarrier
520 a BACKGROUND: Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury.METHODS: Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) (n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR < 1.2 and (2) INR ≥ 1.2. An INR > 1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick's value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers.RESULTS: Patients with iTBI with INR ≥ 1.2 (n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR < 1.2 (n = 72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15-20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as reflected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fibrin monomers increased. Plasminogen activity significantly decreased from 89% in patients with INR < 1.2 to 76% in patients with INR ≥ 1.2. Moreover, D-dimer levels significantly increased from a mean of 943 mg/L in patients with INR < 1.2 to 1,301 mg/L in patients with INR ≥ 1.2.CONCLUSIONS: This more in-depth analysis beyond routine conventional coagulation assays suggests a counterbalanced regulation of coagulation and fibrinolysis in patients with iTBI with hemostatic abnormalities. We observed distinct patterns involving key pathways of the highly complex and dynamic coagulation system that offer windows of opportunity for further research. Whether the changes observed on factor levels may be relevant and explain the worse outcome or the more severe brain injuries by themselves remains speculative.
650 7a MEDICIN OCH HÄLSOVETENSKAPx Klinisk medicinx Anestesi och intensivvård0 (SwePub)302012 hsv//swe
650 7a MEDICAL AND HEALTH SCIENCESx Clinical Medicinex Anesthesiology and Intensive Care0 (SwePub)302012 hsv//eng
653 a CENTER-TBI
653 a Coagulopathy
653 a Fibrin monomers
653 a Progressive intracranial hemorrhage
653 a Thrombin generation
653 a Traumatic brain injury
7001 a Schaeben, Victoria4 aut
7001 a Schäfer, Nadine4 aut
7001 a Güting, Helge4 aut
7001 a Lefering, Rolf4 aut
7001 a Thorn, Sophie4 aut
7001 a Schöchl, Herbert4 aut
7001 a Zipperle, Johannes4 aut
7001 a Grottke, Oliver4 aut
7001 a Rossaint, Rolf4 aut
7001 a Stanworth, Simon4 aut
7001 a Curry, Nicola4 aut
7001 a Maegele, Marc4 aut
7001 a Brorsson, Camillau Umeå universitet,Anestesiologi och intensivvård4 ctb0 (Swepub:umu)brca0001
7001 a Koskinen, Lars-Owe D.,c Professor,d 1955-u Umeå universitet,Institutionen för klinisk vetenskap4 ctb0 (Swepub:umu)lako0002
7001 a Sundström, Ninau Umeå universitet,Institutionen för strålningsvetenskaper4 ctb0 (Swepub:umu)nian0004
7102 a Umeå universitetb Anestesiologi och intensivvård4 org
7730 t Neurocritical Cared : Springerg 36:3, s. 927-941q 36:3<927-941x 1541-6933x 1556-0961
8564 u https://doi.org/10.1007/s12028-021-01400-3y Fulltext
8564 u https://umu.diva-portal.org/smash/get/diva2:1807464/FULLTEXT01.pdfx primaryx Raw objecty fulltext:print
8564 u https://link.springer.com/content/pdf/10.1007/s12028-021-01400-3.pdf
8564 8u https://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-215816
8564 8u https://doi.org/10.1007/s12028-021-01400-3
8564 8u http://kipublications.ki.se/Default.aspx?queryparsed=id:148373349

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