A-174 Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts outcome in Severe Traumatic Brain Injury

Abstract Background Traumatic brain injury (TBI) occurs when a force transmitted to the head or body results in neuropathologic damage and dysfunction. Among these patients, 25% are coagulopathic on admission and trauma-induced coagulopathy (TIC) is associated with an estimated fivefold increase in mortality. TIC is identified by derangements in the conventional coagulation test (CCT) of prothrombin time, international normalized ratio, activated partial thromboplastin time, and platelet counts, but these tests may not assess coagulopathy adequately. Viscoelastic hemostatic techniques like thromboelastography (TEG) and its modifications such as rapid TEG are more precise in identifying the exact derangements of hemostasis compared to conventional methods, especially when they fail to detect the coagulopathy. Methods This was a single-center cross-sectional study conducted in a 2059 bedded level 1 trauma center. Patients over 18 years of age who presented with severe TBI, defined by an initial Glasgow coma scale (GCS) of less than or equal to 8, were screened for inclusion. The patients associated with extracranial injuries, clinical evidence of brain death and secondary admissions, and patients with a history of hemostatic products prior to TEG were excluded. All patients underwent CBC, biochemical tests, CCT, R-TEG after enrolment into the study. TEG was done according to the manufacturer*s protocol by a single operator. From the charts, the following information was extracted: demographics, blood pressure, heart rate, and Glasgow Coma Scale score (GCS). The hemostatic condition was categorized as hypercoagulable, hypocoagulable, and normal based on TEG variables, such as reaction time , time until clot reaches a fixed strength, alpha angle, maximum amplitude, and clotting index. Laboratory parameters and clinical outcomes were compared between hypercoagulable and normal groups. Results One hundred five patients with a median age of 33 (IQR, 17-80) years with male-to-female ratio of 10.6:1 were included. The commonest mechanism of injury was road traffic accidents (75.2%). The overall mortality rate was 36.2% (38/105). The hemostatic condition was categorized as hypercoagulable in 6 (6%), hypocoagulable in 39 (37%), and normal in 60 (57%) based on TEG variables, such as reaction time , time until clot reaches a fixed strength, alpha angle, maximum amplitude, and clotting index. Among the laboratory parameters, WBC was found to be statistically significant between hypocoagulable and normocoagulable groups of patients (P = .018).Among the r-TEG variables that were statistically significant were K-time (p=0.004), alpha angle(<0.0001), MA(<0.0001), EPI (<0.0001), G(<0.0001), E(<0.0001), A (0.001) and ACT (0.016). The sixty day mortality was highest in hypercoagulable followed by hypocoagulable and least in the patients with normal coagulation status. (log-rank test. P=0.358). Conclusion Our results show that TEG could better identify and assess hypercoagulability in patients with s-TBI than conventional coagulation such as PT and aPTT.