Download - Head Injury Coagulopathy
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COAGULOPATHY IN TRAUMA
Literature Study
Warko Karnadihardja
!!"
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INTRO#UCTION$%
•
Injury to the &rain re'ain( the )eadin* +au(e o,death- and )on*$ter' di(a&i)ity a,ter trau'a Sha+k,ord SR et a). Ar+h Sur* %""/- %0. 12%$121
• %31 o, the 4t( 5ith (e6ere T7I die ,ro' their injurie(-
'akin* T7I the nu'&er one +au(e o, death in 4eo4)e
youn*er than 8! year(
• Mo(t death( ,ro' T7I o++ur in the ,ir(t 8 hr( a,ter
injury
• Any inter6ention to ai'in* to redu+e 'orta)ity 'u(t
&e a44)ied ear)y
7oto GR et a). 9 Neura) Neuro Sur* P(y+hiatry !!:- 22. %!18$%!1"
Mae*e)a M et a). ;ur Sur* Red !!2- /". /2$/2"
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INTRO#UCTION$
• #eath and di(a&i)ity in 4t( 5ith T7I are o,ten +au(ed
&y intra 4aren+hy'a) and3or e
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INTRO#UCTION$/
• Ne5 he'orrha*i+ )e(ion( a)(o a44ear 5ithin
hour(- 'akin* thi( a+ute 4eriod +riti+a)
Ser6adei D et a). Neuro (ur*ery %""1. /2. 0""$"!: di(+u((ion "!:$"!2
• ICH 4ro*re((ion i( a (tron* 4redi+tor o, 'orta)ity
•
Da+tor( i'4)i+ated o, ICH 4ro*re((ion. 'a)e*ender- )o5 initia) )e6e) o, +on+iou(ne((- o)der
a*e- 6o)u'e o, initia) he'ato'a- 4ro(en+e o, (4ot
(i*n on CT an*io*ra4hy and +oa*u)o4athy
Wada R et a) . Stroke !!2- /0. %12$%:
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COAGULOPATHY IN T7I
• Coa*u)o4athy i( +o''on in T7I- to ha6e uniEue
+hara+teri(ti+(
• The injured &rain re)ea(e( ti((ue ,a+tor TDB or
thro'&o4)a(tinB- tri**erin* a +on(u'4ti6e
+oa*u)o4athy and hy4er,i&rino)y(i(
• Marked &y hi*h )e6e)( o, #$di'er( ##B
Stein SC- S'ith #h. Neuro +rit Care !!8- %. 82"$800
Hu)ka D- Mu))in* R- Drank ;. Ar+h Sur* %"":. %/:. "/$"0
• A'on* 4t( 5ith &)unt T7I . 0%@ 5ith GCSF : and
%!!@ 5ith GCS (+ore F 1 are +oa*u)o4athi+- 5hi+h i(
inde4endent)y a((o+iated 5ith 'orta)ity
M+Leod 97 et a). 9 Trau'a !!/. 11. /"$88
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CLINICAL #IAGNOSIS OD
COAGULOPATHY
• 7y routine )a4aroto'y te
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THIS STU#Y
• Pro4o(ed to deter'ine 5hether a((o+iatione
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#$#IM;R L;;L AN# MORTALITY
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CONCLUSION
• Thi( (tudy hi*h)i*ht( the a((o+iation
&et5een +oa*u)o4athy and an in+rea(ed ri(k
o, ICH 4ro*re((ion in 4t( 5ith (e6ere T7I
• Coa*u)o4athy 5a( dia*no(ed &y routine+oa*u)ation )a&oratory te
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The ;,,e+t o, 7rain AIS on PT and PTT
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7rain AIS 6( Protein C and Thro'&o'odu)in
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The ;,,e+t o, Injury and Hy4o4er,u(ion on PT and PTT
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The ;,,e+t o, Injury Co'&ined 5ith Hy4o4er,u(ion on
4rotein C and Thro'&o'odu)in
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CONCLUSION
• Re)ea(e o, ti((ue ,a+tor re'ain( i'4ortant
'e+hani(' ,or T7I +oa*u)ation a&nor'a)itie(
• I'4)i+ation o, hy4o4er,u(ion and the 4rotein C4ath5ay in the de6e)o4'ent o, i''ediate
+oa*u)o4athy a,ter trau'a (hou)d ha6e
i'4ortant i'4)i+ation( ,or the dia*no(i( and
treat'ent o, 4o(t trau'a &)eedin*
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Thank You