Coagulation Parameters and Risk of Progressive Hemorrhagic Injury after Traumatic Brain Injury: A Systematic Review and Meta-Analysis

Table 1

Categorization, exposure, continuous data, and definition of PHI of included studies. (Units of measure: PLT, 10⁹/L; PT/PTT, sec; D-dimer, mg/L; Fg, g/L).

Study, the year of publication	Study outcome	Exposure	Cutoff point of every coagulation parameter or coagulopathy	Mean ± SD of PHI group versus non-PHI group	Definition of PHI
Oertel et al., 2002 [8]	PHI	PLT	143	226 ± 74 versus 233 ± 69	PHI was defined as an unambiguous increase in the full film appearance of lesion size; this amounted to a 25% or more increase in at least one dimension of one or more lesions seen on the first postinjury CT scan.
		PT	11.5	12 ± 1.2 versus 12.2 ± 1.5
		PTT	33.4	26.2 ± 5.4 versus 25.2 ± 4.2
Sun et al., 2011 [12]	PHI	PLT	—	166.5 ± 53.5 versus 172.4 ± 57.2	PHI was defined as increased appearance of lesion size, which amounted to no less than a 25% increase in one dimension of one or more lesions from the first postinjury CT scan.
		PT	N/A	—
		PTT	—	25.4 ± 3.5 versus 26.2 ± 5.8
		D-dimer	—	2.1 ± 2.3 versus 1.3 ± 1.1
		FIB	—	2.6 ± 1.7 versus 2.8 ± 2.8
		INR	—	1.9 ± 1.0 versus 1.1 ± 0.5
Tian et al., 2010 [9]	PHI	PLT	100	—	PHI was defined as the appearance of new lesion(s) or a conspicuous increase in the size of hemorrhagic lesion(s), that is, a 25% increase or more versus the first postinjury CT scan.
		PT	17	—
		PTT	48	—
		D-dimer	5	—
		Fg	2.0	2.33 ± 0.62 versus 2.60 ± 0.65
White et al., 2009 [13]	PIH	PLT	—	221 ± 84 versus 245 ± 65	Contusion growth was defined as an increase of at least 33% from the initial volume as measured by image analysis on the second CT compared with the baseline CT scan.
		PTT	—	29 ± 5 versus 28 ± 4
		INR	—	1.4 ± 0.3 versus 1.2 ± 0.2
Tong et al., 2012 [10]	PIH	PLT	100	168.57 ± 55.22 versus 175.91 ± 51.11	PIH was diagnosed if a patient’s repeat CT scan was read as worsening because of new lesions or an increase in the original volume of abnormalities (25% increase in the lesion on the first postinjury CT scan).
		PT	15.5	14.06 ± 1.54 versus 13.39 ± 1.15
		PTT	39	34.67 ± 6.54 versus 34.46 ± 6.39
		D-dimer	2.6	80.20 ± 76.75 versus 11.41 ± 14.05
		Fg	1.8	2.30 ± 1.10 versus 2.56 ± 0.65
Yuan et al., 2012 [11]	PIH	PLT	150	—	PHI was defined as the appearance of new lesions or a conspicuous increase in the size of hemorrhagic lesions (i.e., a 25% increase or more compared to the first postinjury CT scan).
		PT	14	—
		PTT	40	—
		D-dimer	5	—
		Fg	2.0	—
		INR	1.2	—

APTT: activated partial thromboplastin time; D-D: D-dimer; DTICH: delayed traumatic intracerebral/intracranial hemorrhage; Fg/FIB: fibrinogen/fibrin; INR: international normalized ratio; N/A: not available; PHI: progressive hemorrhagic injury; PIH: progressive intracerebral/intracranial hemorrhage; PLT: platelet counts; PT: prothrombin time; SD: standard deviation.