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The Incidence and Significance of Hemostatic Abnormalities in Patients with Head Injuries

 

作者: John Olson,   Howard Kaufman,   Joel Moake,   Thomas O'Gorman,   Keith Hoots,   Karen Wagner,   Kice Brown,   Philip Gildenberg,  

 

期刊: Neurosurgery  (OVID Available online 1989)
卷期: Volume 24, issue 6  

页码: 825-832

 

ISSN:0148-396X

 

年代: 1989

 

出版商: OVID

 

关键词: Central nervous system injury;Coagulation;Disseminated intravascular coagulation;Fibrinolysis;Head injuries

 

数据来源: OVID

 

摘要:

&NA;Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin‐fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test results were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head‐injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients. (Neurosurgery24:825‐832, 1989)

 

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