Hemostatic abnormalities in patients with closed head injuries and their role in predicting early mortality.

Abnormalities of blood coagulation are frequently found in patients following traumatic brain injury. Exposure to thromboplastin, which is abundant in brain, plays an important role in initiating coagulopathy. Eighty patients of moderate-to-severe head injury were screened for platelet count, prothombin time (PT), activated partial thromboplastin time (a-PPTK), fibrinogen degradation product levels (FDP), D-dimer levels, and disseminated intravascular coagulation scores (DIC), calculated within the first 24 hours of injury. Increased consumptive coagulopathy at admission, as reflected by high DIC scores, predicted mortality in both moderate and severe head injury patients with a high degree of accuracy (p < 0.001). Similarly, increased PT, FDP, and D-dimer values correlated with higher mortality in both groups, but platelet counts and a-PPTK values correlated with mortality only in the severe head injury group. From this study we conclude that hemostatic abnormalities are independent predictors of early mortality in moderate-to-severe head injury patients.