What is the role of coagulation profiles in the workup of subdural hematoma (SDH)?

Updated: Jul 26, 2018
  • Author: Richard J Meagher, MD; Chief Editor: Helmi L Lutsep, MD  more...
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Answer

Coagulation profiles are particularly important for patients taking anticoagulants and for alcoholics, who may have an associated coagulopathy placing them at high risk for subdural hematoma. Their altered mental status may be from the hematoma rather than ethanol.

In addition, the prevalence of coagulation abnormalities has long been recognized as unusually high in patients with head injuries. These abnormalities are believed to result from the release of thromboplastic materials by damaged brain tissue.

Stein et al showed that the presence of coagulopathy and the development of delayed brain injury are strongly associated. In a review of 253 patients with head injury who required serial CT scans, the risk of developing a delayed brain insult as seen on CT scan increased from 31% in patients with coagulation study findings within reference range to almost 85% in patients with abnormal findings on prothrombin time (PT), activated partial thromboplastin time (aPTT), or platelet count. [30]

Subdural hematomas themselves were associated with disease progression; 26 of 35 patients with subdural hematoma had expansion of their hematoma or a delayed brain injury seen on a follow-up CT scan. Therefore, all patients with head injury should have at least a basic coagulation panel (PT, aPTT, and platelet count). Fresh frozen plasma or platelets should be given as needed. However, awaiting the results of these studies should not delay emergency surgery.


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