Effects of coagulation dysfunction and platelet changes on rebleeding and prognosis in acute subdural hematoma

To explore the correlation between coagulation indices (prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (APTT), fibrinogen (FIB), and D-dimer) and platelet indices (platelet count, mean platelet volume (MPV), and platelet distribution width (PDW)) and early rebleeding and 2-year prognosis in patients with acute subdural hematoma (aSDH), and to identify independent predictive factors.

A retrospective analysis was performed on 413 aSDH patients treated in the neurosurgery department from February 2018 to February 2021 (training set: 314 patients; validation set: 99 patients). Relevant indices, baseline data, surgical procedures, and 2-year survival rates were recorded. Multivariate logistic/Cox regression analysis was used, and a nomogram model was constructed and validated using ROC curves.

There were no significant differences in baseline data between the two groups. The rebleeding rate in the training set was 29.3%. Patients with rebleeding had lower Glasgow Coma Scale (GCS) scores, higher PT, APTT, and MPV, lower FIB and platelet count, and a higher proportion undergoing craniotomy (all P<0.05). PT, APTT, and MPV were independent risk factors for rebleeding, while craniotomy, FIB, PLT, and GCS were protective factors. The AUC of the nomogram was 0.955 in the training set and 0.928 in the validation set. The 2-year survival rate was 33.70% in the rebleeding group and 88.29% in the non-rebleeding group (P<0.001). Rebleeding, traffic injuries, and prolonged PT were associated with higher mortality.

Prolonged PT, INR, decreased FIB, and decreased platelet counts were associated with an increased risk of early rebleeding and poor 2-year prognosis in aSDH patients. Joint models can effectively stratify risks, but external validation is still required.