Utility of Thromboelastography in Detecting NOAC-Related Coagulopathy in Traumatic Brain Injury

Area of Science:

• Neurology
• Hematology
• Emergency Medicine

Background:

• Novel oral anticoagulants (NOACs) are increasingly used, posing challenges in managing coagulopathy, especially in traumatic brain injury (TBI) patients.
• Elderly patients on NOACs are a growing demographic admitted for TBI, necessitating effective diagnostic tools for coagulopathy.
• Traditional coagulation monitoring may be insufficient for NOACs, highlighting the need for advanced methods.

Purpose of the Study:

• To evaluate the efficacy of thromboelastography (TEG) in identifying NOAC-related coagulopathy in patients with TBI.
• To assess the correlation between TEG findings and the need for coagulation factor administration in TBI patients on NOACs.

Main Methods:

• Retrospective review of 456 TBI patients (2015-2020), focusing on 66 patients on NOACs who underwent TEG at presentation.
• Analysis included TEG parameters, administration of prothrombin complex concentrate (PCC4), repeat head CT for intracranial hemorrhage, and mortality.
• Comparison of outcomes between patients who received PCC4 and those who did not.

Main Results:

• The majority of TEG results in TBI patients on NOACs were within normal limits.
• Despite normal TEG, a significant portion of patients received PCC4.
• Patients receiving PCC4 showed a higher incidence of intracranial hemorrhage progression and increased mortality compared to those who did not.

Conclusions:

• Thromboelastography (TEG) appears unreliable for assessing NOAC-related coagulopathy in TBI patients.
• Clinical interpretation of TEG data in this context requires caution, particularly when guiding reversal strategies.
• Further research is needed to establish optimal management protocols for TBI patients on NOACs.