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. 2017 Apr 5:8:48.
doi: 10.4103/sni.sni_265_16. eCollection 2017.

Point-of-care testing in the acute management of traumatic brain injury: Identifying the coagulopathic patient

Yair M Gozal  1   2 , Christopher P Carroll  1   2 , Bryan M Krueger  1   2 , Jane Khoury  3 , Norberto O Andaluz  1   2   4
Affiliations

Point-of-care testing in the acute management of traumatic brain injury: Identifying the coagulopathic patient

Yair M Gozal et al. Surg Neurol Int. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Aspirin; VerifyNow; coagulopathy; mild traumatic brain injury; thromboelastography.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Percent accuracy of rapid TEG vs INR in the evaluation of mild TBI patients with and without warfarin therapy
Figure 2
Figure 2
Percent accuracy of VN-ASA and rapid TEG in the identification of ASA-induced platelet dysfunction
See this image and copyright information in PMC

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