The influence of hemocoagulation disorders on the development of posttraumatic cerebral infarction and outcome in patients with moderate or severe head trauma

Abstract

Posttraumatic cerebral infarction (PTCI) is a severe secondary insult of head injury and often leads to a poor prognosis. Hemocoagulation disorder is recognized to have important effects on hemorrhagic or ischemic damages. We sought to assess if posttraumatic hemocoagulation disorders were associated with cerebral infarction, and evaluate their influence on outcome among patients with moderate or severe head trauma. In this study, PTCI was observed in 28 (10.57%) of the 265 patients within the first week after injury. In multivariate analysis, the thrombocytopenia (odds ratio (OR) 2.210, 95% confidence interval (CI) 1.065-4.674), abnormal prothrombin time (PT) (OR 3.241, 95% CI 1.090-7.648), D-dimer (>2 mg/L) (OR 7.260, 95% CI 1.822-28.076), or disseminated intravascular coagulation (DIC) scores (≥ 5) (OR 4.717, 95% CI 1.778-12.517) were each independently associated with an increased risk of PTCI. Admission Glasgow Coma Scale (GCS) score, abnormal activated partial thromboplastin time (APTT) and fibrinogen, and D-dimer (>2 mg/L) and DIC scores (≥ 5) showed an independent predictive effect on poor outcome. In conclusion, recognition of this important treatable cause of PTCI and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

Figure 1

Axial CT images of a 35-year-old man with a GCS score of 8 at admission after a motor vehicle collision. Axial CT initially reveals right temporal lobe hematoma. The following CT performed 24 hours and 48 hours after trauma shows well-marginated low density in the left posterior cerebral artery (arrowhead), suggesting infarction (b)-(c). Repeat CT scan 2 weeks after trauma shows brain edema around the damaged areas (d).

Figure 2

Adjusted odds ratios for early posttraumatic cerebral infarction risk factors in the multivariate models. PT: prothrombin time; APTT: activated partial thromboplastin time; DIC: disseminated intravascular coagulation.

Figure 3

Box plots of GCS and of hemocoagulative factors at the time of hospital admission among patients with moderate or severe head injury. Data are shown by GOS 3 months after head trauma. GCS: Glasgow Coma Score; GOS: Glasgow Outcome Score; PLT: platelet; APTT: activated partial thromboplastin time; DIC: disseminated intravascular coagulation.