Relationship between plasma coagulation factor VII and progressive hemorrhagic injury in patients with isolated traumatic brain injury

Abstract

Objective To measure the early changes of plasma coagulation factor Ⅶ (FⅦ) in patients with traumatic brain injury (TBI) and analyze the association between FⅦ and progressive hemorrhagic injury (PHI) so as to provide evidences for treatment of PHI. Methods The study enrolled 112 patients with moderate or severe isolated TBI, aged ≥16 years, who were admitted to the neurotrauma center at Shanghai Huashan Hospital from August 2010 through June 2014. Peripheral blood samples were collected at admission, 24 hours and 48 hours after admission to determine the parameters of international normalized ratio (INR), activated partial thromboplastin time (APTT), platelet count (PLT), D-dimer, fibrinogen (FIB) and FⅦ activity. Follow-up head CT was performed every 24 hours. PHI was defined as when follow-up CT noted any increase in size or number of hemorrhagic lesions. Results Plasma level of FⅦ in patients who developed PHI were significantly lower than those without PHI [0 hour: (77.79 ± 22.82)% vs (100.32±30.39)%; 24 hours: (95.25±28.20)% vs (113.52±21.66)%; 48 hours: (93.02±21.34)% vs (107.69±20.26)%, P 0.05). Logistic regression analysis identified decreases in FⅦ level and platelet count as independent risk factors for the presence of PHI (P<0.05). Conclusion At early stage after TBI, the decreased FⅦ activity and the low platelet level are closely associated with PHI, indicating their importance in guiding treatment of PHI. Key words: Craniocerebral trauma; Intracranial hemorrhages; Coagulation factor Ⅶ; Blood coagulation function