Estudio comparativo sobre la activación precoz de la coagulación y fibrinólisis en el traumatismo craneoencefálico y la hemorragia parenquimatosa espontánea

Introduction. Traumatic brain injury (TBI) and spontaneous intracerebral hemorrhage (SIH) are associated with acute brain injury. Both increase intracranial pressure because of hemorrhages which activate the coagulation system. The relationship between acute brain injury and coagulation activation can be explained by the tissue factor release from the damaged brain to the circulation. This problem has been addressed in several studies, though detailed investigations are lacking mainly in SIH. Objective. To study the activation of hemostasis in a group of patients with TBI and with SIH. Patients and methods. Prospective observational study. Seventy-five intensive care patients were divided in two groups. The first group (n = 45) included TBI and the second (n = 30) SIH. There were 40 healthy persons as a control group. Thrombin-antithrombin III complex, D-dimer and 1 + 2 thrombin fragment levels were measured. Results. All the studied markers were significantly higher in the two patient groups. Thrombin-antithrombin III complex and D-dimer were significantly higher in TBI. We have confirmed a relationship between higher levels of markers and the injury severity, measured with the Glasgow coma scale. Conclusions. Acute brain injury secondary to TBI and SIH activates coagulation system and fibrinolysis early. This activation attempts to achieve a hemostasia status. The activation is more intense in patients with low Glasgow coma scores on admission.