Head Injury Coagulopathy

8/17/2019 Head Injury Coagulopathy

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COAGULOPATHY IN TRAUMA

Literature Study

Warko Karnadihardja

!!"


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INTRO#UCTION$%

•

Injury to the &rain re'ain( the )eadin* +au(e o,death- and )on*$ter' di(a&i)ity a,ter trau'a Sha+k,ord SR et a). Ar+h Sur* %""/- %0. 12%$121

• %31 o, the 4t( 5ith (e6ere T7I die ,ro' their injurie(-

'akin* T7I the nu'&er one +au(e o, death in 4eo4)e

youn*er than 8! year(

• Mo(t death( ,ro' T7I o++ur in the ,ir(t 8 hr( a,ter

injury

• Any inter6ention to ai'in* to redu+e 'orta)ity 'u(t

&e a44)ied ear)y

7oto GR et a). 9 Neura) Neuro Sur* P(y+hiatry !!:- 22. %!18$%!1"

Mae*e)a M et a). ;ur Sur* Red !!2- /". /2$/2"


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INTRO#UCTION$

• #eath and di(a&i)ity in 4t( 5ith T7I are o,ten +au(ed

&y intra 4aren+hy'a) and3or e


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INTRO#UCTION$/

• Ne5 he'orrha*i+ )e(ion( a)(o a44ear 5ithin

hour(- 'akin* thi( a+ute 4eriod +riti+a)

Ser6adei D et a). Neuro (ur*ery %""1. /2. 0""$"!: di(+u((ion "!:$"!2

• ICH 4ro*re((ion i( a (tron* 4redi+tor o, 'orta)ity

•

Da+tor( i'4)i+ated o, ICH 4ro*re((ion. 'a)e*ender- )o5 initia) )e6e) o, +on+iou(ne((- o)der

a*e- 6o)u'e o, initia) he'ato'a- 4ro(en+e o, (4ot

(i*n on CT an*io*ra4hy and +oa*u)o4athy

Wada R et a) . Stroke !!2- /0. %12$%:


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COAGULOPATHY IN T7I

• Coa*u)o4athy i( +o''on in T7I- to ha6e uniEue

+hara+teri(ti+(

• The injured &rain re)ea(e( ti((ue ,a+tor TDB or

thro'&o4)a(tinB- tri**erin* a +on(u'4ti6e

+oa*u)o4athy and hy4er,i&rino)y(i(

• Marked &y hi*h )e6e)( o, #$di'er( ##B

Stein SC- S'ith #h. Neuro +rit Care !!8- %. 82"$800

Hu)ka D- Mu))in* R- Drank ;. Ar+h Sur* %"":. %/:. "/$"0

• A'on* 4t( 5ith &)unt T7I . 0%@ 5ith GCSF : and

%!!@ 5ith GCS (+ore F 1 are +oa*u)o4athi+- 5hi+h i(

inde4endent)y a((o+iated 5ith 'orta)ity

M+Leod 97 et a). 9 Trau'a !!/. 11. /"$88


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CLINICAL #IAGNOSIS OD

COAGULOPATHY

• 7y routine )a4aroto'y te


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THIS STU#Y

• Pro4o(ed to deter'ine 5hether a((o+iatione


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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9 Trau'a No6 !!"- :2. "11$":2


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#$#IM;R L;;L AN# MORTALITY

9 Trau'a No6 !!"- :2. "11$":2


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CONCLUSION

• Thi( (tudy hi*h)i*ht( the a((o+iation

&et5een +oa*u)o4athy and an in+rea(ed ri(k

o, ICH 4ro*re((ion in 4t( 5ith (e6ere T7I

• Coa*u)o4athy 5a( dia*no(ed &y routine+oa*u)ation )a&oratory te


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The ;,,e+t o, 7rain AIS on PT and PTT


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7rain AIS 6( Protein C and Thro'&o'odu)in


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The ;,,e+t o, Injury and Hy4o4er,u(ion on PT and PTT


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The ;,,e+t o, Injury Co'&ined 5ith Hy4o4er,u(ion on

4rotein C and Thro'&o'odu)in


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CONCLUSION

• Re)ea(e o, ti((ue ,a+tor re'ain( i'4ortant

'e+hani(' ,or T7I +oa*u)ation a&nor'a)itie(

• I'4)i+ation o, hy4o4er,u(ion and the 4rotein C4ath5ay in the de6e)o4'ent o, i''ediate

+oa*u)o4athy a,ter trau'a (hou)d ha6e

i'4ortant i'4)i+ation( ,or the dia*no(i( and

treat'ent o, 4o(t trau'a &)eedin*


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Thank You

Head Injury Coagulopathy

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