Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury
A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historic...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/21/5039 |
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| author | Jamie L. Bradbury Scott G. Thomas Nikki R. Sorg Nicolas Mjaess Margaret R. Berquist Toby J. Brenner Jack H. Langford Mathew K. Marsee Ashton N. Moody Connor M. Bunch Sandeep R. Sing Mahmoud D. Al-Fadhl Qussai Salamah Tarek Saleh Neal B. Patel Kashif A. Shaikh Stephen M. Smith Walter S. Langheinrich Daniel H. Fulkerson Sherry Sixta |
| author_facet | Jamie L. Bradbury Scott G. Thomas Nikki R. Sorg Nicolas Mjaess Margaret R. Berquist Toby J. Brenner Jack H. Langford Mathew K. Marsee Ashton N. Moody Connor M. Bunch Sandeep R. Sing Mahmoud D. Al-Fadhl Qussai Salamah Tarek Saleh Neal B. Patel Kashif A. Shaikh Stephen M. Smith Walter S. Langheinrich Daniel H. Fulkerson Sherry Sixta |
| author_sort | Jamie L. Bradbury |
| collection | DOAJ |
| description | A unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes. |
| first_indexed | 2024-03-10T05:59:53Z |
| format | Article |
| id | doaj.art-8ef354478256474da1db45dd610ef438 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T05:59:53Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-8ef354478256474da1db45dd610ef4382023-11-22T21:06:23ZengMDPI AGJournal of Clinical Medicine2077-03832021-10-011021503910.3390/jcm10215039Viscoelastic Testing and Coagulopathy of Traumatic Brain InjuryJamie L. Bradbury0Scott G. Thomas1Nikki R. Sorg2Nicolas Mjaess3Margaret R. Berquist4Toby J. Brenner5Jack H. Langford6Mathew K. Marsee7Ashton N. Moody8Connor M. Bunch9Sandeep R. Sing10Mahmoud D. Al-Fadhl11Qussai Salamah12Tarek Saleh13Neal B. Patel14Kashif A. Shaikh15Stephen M. Smith16Walter S. Langheinrich17Daniel H. Fulkerson18Sherry Sixta19Department of Neurosurgery, Indiana University School of Medicine, Indianapolis, IN 46202, USADepartment of Trauma Surgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Emergency Medicine, Indiana University School of Medicine—South Bend, South Bend, IN 46617, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Otolaryngology, Portsmouth Naval Medical Center, Portsmouth, VA 23708, USADepartment of Emergency Medicine, Indiana University School of Medicine—South Bend, South Bend, IN 46617, USADepartment of Emergency Medicine, Indiana University School of Medicine—South Bend, South Bend, IN 46617, USADepartment of Emergency Medicine, Indiana University School of Medicine—South Bend, South Bend, IN 46617, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Intensive Care Medicine, St. Joseph Regional Medical Center, Mishawaka, IN 46545, USADepartment of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Neurosurgery, Memorial Hospital, South Bend, IN 46601, USADepartment of Trauma Surgery, Envision Physician Services, Plano, TX 75093, USAA unique coagulopathy often manifests following traumatic brain injury, leading the clinician down a difficult decision path on appropriate prophylaxis and therapy. Conventional coagulation assays—such as prothrombin time, partial thromboplastin time, and international normalized ratio—have historically been utilized to assess hemostasis and guide treatment following traumatic brain injury. However, these plasma-based assays alone often lack the sensitivity to diagnose and adequately treat coagulopathy associated with traumatic brain injury. Here, we review the whole blood coagulation assays termed viscoelastic tests and their use in traumatic brain injury. Modified viscoelastic tests with platelet function assays have helped elucidate the underlying pathophysiology and guide clinical decisions in a goal-directed fashion. Platelet dysfunction appears to underlie most coagulopathies in this patient population, particularly at the adenosine diphosphate and/or arachidonic acid receptors. Future research will focus not only on the utility of viscoelastic tests in diagnosing coagulopathy in traumatic brain injury, but also on better defining the use of these tests as evidence-based and/or precision-based tools to improve patient outcomes.https://www.mdpi.com/2077-0383/10/21/5039adenosine diphosphatearachidonic acidblood plateletsbrain injuriestraumaticcerebral hemorrhage |
| spellingShingle | Jamie L. Bradbury Scott G. Thomas Nikki R. Sorg Nicolas Mjaess Margaret R. Berquist Toby J. Brenner Jack H. Langford Mathew K. Marsee Ashton N. Moody Connor M. Bunch Sandeep R. Sing Mahmoud D. Al-Fadhl Qussai Salamah Tarek Saleh Neal B. Patel Kashif A. Shaikh Stephen M. Smith Walter S. Langheinrich Daniel H. Fulkerson Sherry Sixta Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury Journal of Clinical Medicine adenosine diphosphate arachidonic acid blood platelets brain injuries traumatic cerebral hemorrhage |
| title | Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury |
| title_full | Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury |
| title_fullStr | Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury |
| title_full_unstemmed | Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury |
| title_short | Viscoelastic Testing and Coagulopathy of Traumatic Brain Injury |
| title_sort | viscoelastic testing and coagulopathy of traumatic brain injury |
| topic | adenosine diphosphate arachidonic acid blood platelets brain injuries traumatic cerebral hemorrhage |
| url | https://www.mdpi.com/2077-0383/10/21/5039 |
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