Procoagulant activity in patients with isolated severe head trauma

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Abstract
To determine the degree of regional and systemic coagulation activation soon after isolated severe head injury. Prospective, controlled clinical study. The emergency room and intensive care unit (ICU) of a trauma center in a university hospital serving a population of 5 million people. Twenty-four trauma victims: 20 patients with isolated severe head injury (head trauma group, Glasgow Coma Score of Insertion of central venous, i.e. superior caval vein, jugular bulb, and arterial catheters for blood sampling. Central venous (i.e., superior caval vein) global coagulation variables (i.e., prothrombin time, activated partial thromboplastin time, fibrinogen concentration, antithrombin III activity, and platelet count) and central venous and jugular bulb activation coagulation and fibrinolysis variables (i.e., prothrombin fragment F1+2, thrombin-antithrombin III complex, soluble fibrin, and D-dimer concentration) were measured soon after trauma ( Within 6 hrs after severe isolated head trauma, systemic procoagulant overflow from the traumatized cerebral microvasculature proceeds to the thrombin level and is then inhibited by antithrombin III. Regional and systemic hypercoagulability and increased D-dimer concentrations appear to be common among head trauma patients. Increased procoagulant and consecutive fibrinolytic turnover may, therefore, spark disseminated intravascular coagulation in this patient group. (Crit Care Med 1998; 26:149-156)