Abstract

Background—aimTraumatic brain injury (TBI) and alcohol use disorder (AUD) can occur concomitantly and be associated with coagulopathy that influences TBI outcome. The use of bleeding time tests in TBI management is controversial. We hypothesized that in TBI patients with AUD, a prolonged bleeding time is associated with more severe injury and poor outcome.Material and methodsModerate and severe TBI patients with evidence of AUD were examined with bleeding time according to IVY bleeding time on admission during neurointensive care. Baseline clinical and radiological characteristics were recorded. A standardized IVY bleeding time test was determined by staff trained in the procedure. Bleeding time test results were divided into normal (≤ 600 s), prolonged (> 600 s), and markedly prolonged (≥ 900 s). Normal platelet count (PLT) was defined as > 150,000/μL. This cohort was compared with another group of TBI patients without evidence of AUD.ResultsFifty-two patients with TBI and AUD were identified, and 121 TBI patients without any history of AUD were used as controls. PLT was low in 44.2% and bleeding time was prolonged in 69.2% of patients. Bleeding time values negatively correlated with PLT (p < 0.05). TBI patients with markedly prolonged values (≥ 900 s) had significantly increased hematoma size, and more frequently required intracranial pressure measurement and mechanical ventilation compared with those with bleeding times < 900 s (p < 0.05). Most patients (88%) with low platelet count had prolonged bleeding time. No difference in 6-month outcome between the bleeding time groups was observed (p > 0.05). Subjects with TBI and no evidence for AUD had lower bleeding time values and higher platelet count compared with those with TBI and history of AUD (p < 0.05).ConclusionsAlthough differences in the bleeding time values between TBI cohorts exist and prolonged values may be seen even in patients with normal platelet count, the bleeding test is a marker of primary hemostasis and platelet function with low specificity. However, it may provide an additional assessment in the interpretation of the overall status of TBI patients with AUD. Therefore, the bleeding time test should only be used in combination with the patient’s bleeding history and careful assessment of other hematologic parameters.

Highlights

  • Traumatic brain injury (TBI) is frequently associated with coagulation abnormalities which may negatively influence outcome [12, 27, 32, 43, 46, 51]

  • Following TBI, acute and chronic alcohol use may predispose to hemorrhage by influencing coagulation and fibrinolytic systems which may in turn exacerbate outcome [21, 36]

  • The study was retrospectively performed in the Department of Neurosurgery at Uppsala University Hospital, Uppsala, Sweden, where the IVY bleeding time test is routinely used in neurosurgical patients with a clinical suspicion of coagulopathy

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Summary

Introduction

Traumatic brain injury (TBI) is frequently associated with coagulation abnormalities which may negatively influence outcome [12, 27, 32, 43, 46, 51]. The underlying mechanisms leading to hemostatic problems following TBI are complex involving factors which can either separately or synergistically impair components of the coagulation system leading to platelet dysfunction and increased fibrinolysis [14, 23, 32, 42, 51, 57]. Following TBI, acute and chronic alcohol use may predispose to hemorrhage by influencing coagulation and fibrinolytic systems which may in turn exacerbate outcome [21, 36]

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