J Neurocrit Care.  2019 Jun;12(1):9-19. 10.18700/jnc.190086.

Assessment and management of coagulopathy in neurocritical care

• Salem AM
• Roh D
• Kitagawa R
• Choi HA
• Chang TR

• KMID: 2452822
• DOI: http://doi.org/10.18700/jnc.190086

Abstract

Coagulopathy may be defined as the loss of balance between hemostatic and fibrinolytic processes resulting in excessive bleeding, intravascular thrombosis or abnormalities in coagulation testing. It is frequently encountered across a wide range of conditions seen in the neurocritical care unit and can contribute to poor outcomes. Early recognition and appropriate management are key, with traumatic brain injury, acute ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage presenting unique challenges to the neurointensivist. We will discuss techniques to assess coagulopathies as well as treatment strategies for the brain injured patient.

Keyword

Anticoagulants; Platelet aggregation inhibitors; Blood coagulation disorders; Thrombelastrography; Subarachnoid hemorrhage; Brain injuries, traumatic

MeSH Terms

Anticoagulants
Blood Coagulation Disorders
Brain
Brain Injuries
Cerebral Hemorrhage
Hemorrhage
Humans
Platelet Aggregation Inhibitors
Stroke
Subarachnoid Hemorrhage
Thrombosis
Anticoagulants
Platelet Aggregation Inhibitors

Figure

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  Fig. 1. (A) Schematic of viscoelastic testing with specimen of whole blood in cup. With thrombelastography (TEG) the cup oscillates with pin remaining stationary, while with ROTEM pin oscillates while the cup remains stationary. Measurement of pin synchronization with the cup reflects the stages of clot formation. (B) TEG recording with measurement parameters.

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