Activity of factor VII in patients with isolated blunt traumatic brain injury: association with coagulopathy and progressive hemorrhagic injury.

Abstract

BACKGROUND:

Given the importance of factor VII (FVII) in extrinsic pathway of coagulation cascade, we sought to elucidate the relationship between FVII and traumatic brain injury-induced coagulopathy and progressive hemorrhagic injury (PHI).

METHODS:

Eighty-one patients with isolated traumatic brain injury, 16 years or older, were recruited between 2010 and 2012. Blood was collected on arrival in the emergency department and analyzed with activated partial thromboplastic time, international normalized ratio, platelet count, and activity of FVII. Coagulopathy was defined as thrombocytopenia (platelet count < 120,000/μL) or elevated international normalized ratio of greater than 1.2 or prolonged activated partial thromboplastin time greater than 40 seconds at admission. PHI was present when the follow-up computed tomographic scan reported any increase in size or number of the hemorrhagic lesions. Logistic regression examined the risks for coagulopathy and PHI.

RESULTS:

Mean (SD) FVII activity in patients with coagulopathy was 85.69% (34.88%), which was significantly lower than patients without coagulopathy (99.57% [29.37%], p = 0.04). Isolated traumatic brain injury patients with FVII activity less than 77.5% have an odds ratio for coagulopathy of 5.52 (95% confidence interval, 1.82-16.68; p = 0.03) relative to patients with FVII activity of 77.5% or greater. Mean (SD) FVII activity in patients with PHI was 70.76% (18.21%), which was significantly lower than patients without PHI (105.76% [32.27%], p < 0.001). A stepwise logistic regression analysis identified FVII less than 77.5% (odds ratio, 4.53; 95% confidence interval, 1.62-12.67; p = 0.004) as a predisposing risk factors independently associated with the presence of PHI. The overall mortality rate in the study population was 7.4% (n = 6). The plasma FVII in death patients (91.44% [47.19%]) was slightly lower than that in survival patients (92.01% [32.04%]). However, there was no statistical difference between the two groups (p = 0.95).

CONCLUSION:

A decrease of FVII activity significantly contributes to the coagulopathy and PHI in patients with isolated traumatic brain injury.

LEVEL OF EVIDENCE:

Prognostic study, level III.

• Authors: Xing Wu, Zhuoying Du, Jian Yu, Yirui Sun, Bingbing Pei, Xin Lu, Zhengyu Tang, Mao Yin, Liangfu Zhou, Jin Hu
• Journal: The journal of trauma and acute care surgery (J Trauma Acute Care Surg) Vol. 76 Issue 1 Pg. 114-20 (Jan 2014) ISSN: 2163-0763 [Electronic] United States
• PMID: 24368365 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Factor VII

Topics

• Blood Coagulation Disorders (blood, etiology, physiopathology)
• Factor VII (physiology)
• Female
• Head Injuries, Closed (blood, complications, mortality, physiopathology)
• Humans
• International Normalized Ratio
• Intracranial Hemorrhage, Traumatic (blood, complications, mortality, physiopathology)
• Male
• Middle Aged
• Partial Thromboplastin Time
• Platelet Count
• Prospective Studies
• Thrombocytopenia (etiology)