An overview of post–traumatic coagulopathy in elderly patients with traumatic brain injury who suffer from “talk and deteriorate”

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  • 高齢者頭部外傷におけるtalk and deteriorateのリアル
  • コウレイシャ トウブ ガイショウ ニ オケル talk and deteriorate ノ リアル

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Abstract

<p>  Survival curve analyses of patients with a traumatic brain injury (TBI) have shown that the mortality rate after the first 48 hr of trauma is high in the elderly, due mainly to delayed deterioration, or the so‒called “talk and deteriorate (T&D)” status. This study investigated the relationship between coagulopathy and T&D in 270 elderly patients with TBI (154 males, 119 females, 79.0±8.3 yrs old). The patients were assigned to the T&D group (n＝94) and non‒T&D group (n＝176). Clinical indicators were retrospectively compared between these groups, including age, gender, mechanism of TBI, Glasgow Coma Scale (GCS), initial appearance on CT, serum parameters of coagulopathy, Glasgow Outcome Scale (GOS), and more. The patients were also divided based on whether they had been preconditioned by antithrombotic agents, i.e., preconditioned (n＝126) and non‒preconditioned (n＝144) groups for a comparison of their T&D rates. There were no significant difference between the T&D and non‒T&D groups in age, gender, TBI mechanism, or initial appearance on CT. Serum D‒dimer was significantly higher in the T&D group (70.0±86.2 μg/mL) compared to the non‒T&D group (28.2±50.4 μg/mL). The prothrombin time and international normalized ratio (PT/INR) was significantly higher in the T&D group (1.39±0.90) versus the non‒T&D group (1.04±0.22). The activated partial thromboplastin time (APTT) was significantly longer in the patients with T&D (32.0±9.4 s) compared to the non‒T&D group (29.3±5.9 s). The platelet count was significantly lower in T&D (16.6±6.5×104/μL) than non‒T&D (19.5±6.5×104/μL). The serum Na was significantly lower in T&D (138.6±5.0 mEq/L) versus non‒T&D group (140.0±4.2 mEq/L). The deterioration rate was significantly higher in the group of patients preconditioned by an antithrombotic agent than in those who were non‒preconditioned. As the cause of T&D, enlargement of intracranial hematomas was most frequent, but other causes (e.g., cerebral edema, epilepsy, cerebral infarction, and hydrocephalus) were not rare. The GOS was significantly worse in the T&D group compared to the non‒T&D group (p ＜ 0.001). These results suggest that coagulopathy or preconditioning with antithrombotic agents is closely associated with the occurrence of T&D.</p>

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