Background: Traumatic brain injury (TBI) is frequently associated with coagulopathy and increased mortality risk. Thromboelastography can provide rapid coagulation assessment and may be particularly useful in distinguishing coagulapathic TBI (CTBI) profiles and severity, aiding goal-directed treatment of CTBI patients.

Aims: To conduct a systematic review and outcomes analysis to assess the utility of thromboelastography for evaluation and management of CTBI patients.

Methods: A systematic literature search was performed on PubMed and EMBASE to identify clinical studies of adult patients with TBI assessed using thromboelastography. Articles were screened using predefined inclusion and exclusion criteria. Demographic, diagnostic, laboratory, treatment, and outcome data were extracted for comparison and an aggregate analysis performed to compare the effect of CTBI management with thromboelastography versus conventional coagulation assays (CCA) on 28-day mortality.

Results: Searches identified 303 non-duplicate publications with seven additional manuscripts identified by the authors. After screening and review, 29 publications were identified with relevant data on the use of thromboelastography in CTBI patients. Results showed that thromboelastography identified hypercoagulable patterns in TBI patients. Notably, the K-value, α angle and MA values consistently differed from established reference ranges. Furthermore, thromboelastography parameters differed between TBI subtypes; penetrating TBI was associated with increased likelihood of coagulopathy, evidenced by significant differences in all TEG parameters (except R time), compared with blunt TBI. Thromboelastography assays were also able to predict a range of clinical outcomes including mortality, neurosurgical intervention, and bleeding complications, with evidence for improved outcomes following thromboelastography guided blood transfusion in TBI patients. Two studies were identified for an aggregate analysis, and demonstrated a significant mortality benefit of using viscoelastic testing to guide resuscitation in TBI patients compared to CCA (Figure 1).Effect of thromboelastography guided treatment on mortality in TBI patients

Conclusions: Thromboelastography may have an important role in both the diagnosis and management of patients with TBI. Further studies are needed to define optimal use.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/thromboelastography-for-the-evaluation-and-management-of-patients-with-traumatic-brain-injury/