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Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study

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Abstract

Introduction

Traumatic brain injury (TBI) is associated with a hypercoagulable state, the mechanism and duration of which remain unclear. We sought to determine whether thromboelastography (TEG) analysis could identify the hypercoagulable state after TBI, as defined by elevations in maximal amplitude (MA), thrombus generation (TG), G value (G), and alpha angle (αA).

Methods

Patients with moderate–severe TBI, defined primarily as a GCS <12, admitted between 1/2012 and 8/2013 were eligible for enrolment in this prospective cohort study. TEG profiles were obtained between 0–24 h (T1), 24–48 h (T2), 48–72 h (T3), 72–96 h (T4), and 96–120 h (T5) after admission. Early TEG was defined as 0–48 h, and late TEG was defined as >48 h.

Results

Twenty five patients (80 % men) and 7 age- and sex-matched control subjects were studied. Median age was 38 years (range 18–85). Early MA was [63.6 mm (60.5, 67.4)] versus late MA [69.9 mm (65.2,73.9); p = 0.02], early TG was [763.3 mm/min (712.8, 816.2)] versus late TG [835.9 mm/min (791.2,888.3); p = 0.02], and early G was [8.8 d/cm2 (7.7,10.4)] versus late G [11.6 d/cm2 (9.4,14.1); p = 0.02]. Study patients had higher MA (p = 0.02), TG (p = 0.03), and G (p = 0.02) values at T5 compared to controls. There was a linear increase per day of MA by 2.6 mm (p = 0.001), TG 31.9 mm/min (p ≤ 0.001), and G value by 1.3 d/cm2 (p ≤ 0.001) when clustered by pairs in regression analysis. Lower MA values trended toward home discharge (p = 0.08).

Conclusion

The data suggest a progressive and delayed hypercoagulable state observed days after initial TBI. The hypercoagulable state may reflect excess platelet activity.

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Acknowlegments

Dr. Kumar has received research support from Haemonetics. Dr. Kasner has received grants from WL Gore, AstraZeneca, GlaxoSmithKline, and Acorda. He acts as a consultant for Merck, Novartis, Medtronic, and Boehringer Ingelheim. Dr. Grady has received Grant funding from the NIH. For the remaining authors, none were declared.

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Authors and Affiliations

  1. Department of Neurology, Perelman School of Medicine and the Hospital of the University of Pennsylvania, 3 West Gates Building, 3400 Spruce Street, Philadelphia, PA, 19104, USA

    Allie M. Massaro, Scott E. Kasner & Monisha A. Kumar

  2. Department of Neurosurgery, Perelman School of Medicine and the Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Sean Doerfler, Kelsey Nawalinski, Bernard Michel, Nicolette Driscoll, Connie Ju, Hiren Patel, Francis Quattrone, Suzanne Frangos, Eileen Maloney-Wilensky, Michael Sean Grady, Sherman C. Stein & Monisha A. Kumar

  3. Department of Anesthesiology & Critical Care, Perelman School of Medicine and the Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA

    Monisha A. Kumar

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  1. Allie M. Massaro
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Correspondence to Allie M. Massaro.

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Massaro, A.M., Doerfler, S., Nawalinski, K. et al. Thromboelastography Defines Late Hypercoagulability After TBI: A Pilot Study. Neurocrit Care 22, 45–51 (2015). https://doi.org/10.1007/s12028-014-0051-3

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