Thromboelastometric (ROTEM) versus standard coagulation test (SCT) results in patients with traumatic brain injury (TBI) undergoing craniotomy

Abstract

Background and Goal of Study: Coagulopathy (CP) is a common finding in TBI patients associated with secondary brain damage. However, there is no clear guidance to the clinician on how CP should be managed. SCT have significant limitations. Viscoelastic tests (e.g. ROTEM) reflect whole blood coagulation from initiation to fibrinolysis and may add important information. We aimed to identify dynamic changes in coagulation, and to clarify associations between SCT and ROTEM results in patients with TBI undergoing craniotomy. Materials and Methods: We present preliminary results of a prospective study in adult TBI patients undergoing urgent craniotomy. Patients with polytrauma (AISextracranial>3), hematologic disease, use of anticoagulants or antiplatelets, were not included. Blood was collected pre- (day 0) and post-operatively (days 1, 2, 3) and analyzed with SCT (prothrombin time index [PTI], partial thromboplastine time [APTT], platelet count [PLT], fibrinogen concentration [FIB]), and ROTEM assays (EXTEM, INTEM, FIBTEM). CP was considered as any deviation from normal coagulation test values. Dynamic changes of ROTEM and SCT results as well as interrelationships between them were investigated. Significance level for comparisons, p<0.05. Results and Discussion: 69 patients were included. Patient coagulation profile was generally good and coagulation test abnormalities were mild. Significant negative trends were observed in PTI, APTT and PLT until day 2, whereas FIB increased from day 1. CP prevalence according to SCT increased from 36.2% (day 0) to 71.9% (day 2). Notably, ROTEM parameters generally improved from day 1, and CP prevalence according to ROTEM decreased from 36.2% (day 0) to 16.4% (day 3). EXTEM and INTEM CFT, A10 and MCF showed significant correlations (mostly moderate to strong) with PLT and FIB. FIBTEM A10 and MCF correlated strongly with FIB. Relationships between APTT and PTI with INTEM CT and EX[...].