Implementation of Thromboelastometry for Coagulation Management in Isolated Traumatic Brain Injury Patients...

Area of Science:

• Neuroscience
• Trauma Surgery
• Hematology

Background:

• Coagulopathy (CP) is a significant factor in secondary brain damage and poor outcomes following traumatic brain injury (TBI).
• Recent trends show a move towards goal-directed coagulation management strategies.
• Standard coagulation tests (SCT) have limitations in fully assessing TBI-related coagulopathy.

Purpose of the Study:

• To investigate the feasibility and impact of rotational thromboelastometry (ROTEM)-based management in adult TBI patients requiring craniotomy.
• To compare outcomes between TBI patients managed with ROTEM versus standard coagulation tests (SCT).

Main Methods:

• A prospective, case-control study involving 134 adult TBI patients undergoing craniotomy.
• Patients were divided into a control group (SCT-guided management) and a case group (ROTEM-guided management).
• Outcome measures included coagulopathy rates, protocol adherence, blood loss, transfusions, progressive hemorrhagic injury (PHI), re-intervention, Glasgow Coma Score (GCS), Glasgow Outcome Score (GOS), and mortality.

Main Results:

• ROTEM-guided management demonstrated an 85.3% protocol adhesion rate.
• Postoperative ROTEM parameters significantly improved in the case group, reducing the incidence of coagulopathy.
• ROTEM guidance led to a significant decrease in progressive hemorrhagic injury (PHI) and neurosurgical re-interventions compared to SCT.

Conclusions:

• Rotational thromboelastometry (ROTEM) enables consistent coagulation management in TBI patients.
• ROTEM improves clot quality and reduces the incidence of progressive hemorrhagic injury and the need for re-intervention.
• Further research is warranted to confirm the definitive benefits of ROTEM in TBI management.