Introduction: Coagulopathy following traumatic brain injury (TBI) is an often devastating phenomenon that is associated with significant increases in both morbidity and mortality. The use of rapid thromboelastography (r-TEG), while well described in the general trauma literature, has not been extensively investigated as a primary screening tool for coagulopathy in TBI patients. We sought to determine the role of r-TEG in hemostatic resuscitation of TBI patients.
Methods: A retrospective review of 61 TBI patients who underwent r-TEG as part of their admission coagulopathy workup was conducted. Medical history, with particular emphasis on the use of anticoagulants, was recorded. Coagulation deficiency was defined as an INR > 1.3 or a reaction time (r-value) > 50 seconds.
Results: Sixteen patients were classified as hypocoagulable based on their INR on admission. Of these, 12 (75%) reported ongoing warfarin usage with 10 patients demonstrating a concomitantly increased r-value. Of the remaining 45 patients with normal INR, 21 (47%) demonstrated a significantly elevated r-value consistent with coagulopathy. Interestingly, three patients with normal INR reported warfarin usage with all three exhibiting abnormally elevated r-values.
Conclusions: In comparison with INR, r-TEG is a highly sensitive assay of coagulopathy in the acute setting following TBI. The lack of concordance between these two lab tests in patients with normal INR highlights the importance of applying r-TEG to help drive the hemostatic resuscitation of TBI patients whose coagulopathy would have otherwise been missed. Similarly, as the r-value can be read very quickly in real-time, rTEG may allow for rapid reassessment of the need for continued transfusions in hypocoagulable TBI patients or those with pre-injury exposure to warfarin.
Patient Care: By helping identify TBI patients with normal coagulation tests who are prone to bleeding
Learning Objectives: 1) Understand the adverse outcomes and socioeconomic cost associated with coagulopathy in TBI 2) Identify the differences between conventional coagulation tests and r-TEG 3) Understand the effective application of r-TEG in guiding decisions regarding the administration of blood products for correction of coagulopathy in TBI patients.