Thrombocytopenia and Coagulopathy in Indian Patients With Isolated Head Trauma

  • Ruchika Sodhi University College of Medical Science &GTB hospital, Delhi
  • Meera Sikka University College of Medical Science &GTB hospital, Delhi
  • Mrinalini Kotru University College of Medical Science &GTB hospital, Delhi
  • Gurubachan Singh University College of Medical Science &GTB hospital, Delhi
Keywords: Coagulopathy, head trauma, prothrombin time, activated partial thromboplastin time, thrombocytopenia


Background: Patients with head injury, a leading cause of morbidity and mortality worldwide are susceptible to the early development of coagulopathy. As its presence further contributes to an adverse outcome, early identification assumes importance. This study aimed to assess the  prevalence  and  nature  of  hemostatic  abnormalities  in  Indian patients  with  isolated head trauma and  correlate them with outcome.Methods: Complete blood counts with platelet count and screening tests of hemostasis PT, APTT, TT were performed on 100 patients with isolated head trauma admitted within 12hrs of injury. The severity of injury was assessed by Glasgow coma score (GCS).Result: Based on the GCS, head injury was classified as mild (GCS 13-15, n=45), moderate (GCS 9-12, n=28) and severe (GCS 3-8, n=27). Thrombocytopenia was present in 48% patients. Coagulopathy [prolonged PT (>14 sec) and/or APTT (>34 sec)] was present in 39% patients. Twenty-six patients died. Mortality was significantly (p<0.001) higher in patients with coagulopathy and/or thrombocytopenia. Platelet count was significantly lower and PT, APTT, TT significantly (p<0.001) higher in non survivors as compared to survivors. Platelet count significantly (p<0.05) decreased while PT, APTT and TT increased with increasing severity of injury. Seven (17.9%) patients with mild injury also had coagulopathy.Conclusion: Coagulopathy and thrombocytopenia were associated with a significantly higher mortality and was present even in patients with mild head injury. Measurement of hemostatic parameters in these patients   irrespective of severity of injury will help in identification of patients at poor risk thus aiding better management and improved survival. DOI: 10.21276/APALM.1617

Author Biographies

Ruchika Sodhi, University College of Medical Science &GTB hospital, Delhi
MD Pathology
Meera Sikka, University College of Medical Science &GTB hospital, Delhi
MD Pathology, Professor& Head of Department
Mrinalini Kotru, University College of Medical Science &GTB hospital, Delhi
DM Hematopathology
Gurubachan Singh, University College of Medical Science &GTB hospital, Delhi
Mch Neurosurgery, Professor and Head of Department


1. Mc Naughtan H, Ardagh M, Beattie A, Dharan V, Dudley M, Dyson C, Niumata-Faleafa M, Finucane G, Hall K, Harwood M, et al. Traumatic Brain Injury: Diagnosis, Acute management and Rehabilitation. Evidence based best practice guideline summary. New Zealand Guidelines Group. 2007; March.

2. Dutton RP, McCunn. Traumatic Brain Injury. CurrOpinCrit Care.2003 Dec; 9(6):503-509.

3. Gerlach R, Krause M, Seifert V, Goerlinger K. Hemostatic and hemorrhagic problems in neurosurgical patients. J ActaNeurochir (Wien) . 2009 Aug; 151(8):873-900.

4. Chiaretti A, Piastra M, Pulitano S, Pietrini D, De Rosa G, Barbaro R, Di Rocco C. Prognostic factors and outcome of children with severe head injury: an 8-year experience. Childs Nerv Syst. 2002 Apr;18(3-4):129-136.

5. Carrick MM, Tyroch AH, Yousens CA, Handley T. Subsequent development of thrombocytopenia and coagulopathy in moderate and severe head injury:Support for serial laboratory examination. J Trauma. 2005 Apr;58(4):725-730.

6. Ueda S, Fujitsu K, Fujino H, Sekino T, Kuwabara T. Correlation between plasma fibrin-fibrinogen degradation product values and CT findings in head injury. J NeurolNeurosurg Psychiatry. 1985 Jan; 48(1):58-60.

7. Jennett B, Teasdale G, Galbraith S, Pickard J, Grant H, Braakman R, Avezaat C, Maas A, Minderhoud J, Vecht CJ, Heiden J, Small R, Caton W, KurzeTe. Severe head injuries in three countries. J NeurolNeurosurg Psychiatry. 1977 Mar; 40(3): 291-298.

8. De Maeyer EM, Adiels-Tegman M. The prevalence of anemia in the world-World Health Statistics Quaterly. 1985; 38:302-316.

9. McGarry LJ, Thompson D, Millham FH, Cowell L, Snyder PJ, Lenderking WR, Weinstein MC. Outcomes and costs of acute treatment of traumatic brain injury. J Trauma. 2002 Dec; 53(6):1152-1159.

10. quoted from Levine JM, Kumar MA. Traumatic brain injury. Neurocritical Care Society Practise Update 2013.

11. Olson JD, Kaufman HH, Moake J, O’Gorman TW, Hoots K, Wagner K, Brown CK, Gildenberg PL. The incidence and significance of hemostatic abnormalities in patients with head injuries. Neurosurgery. 1989 Jun; 24(6):825-832.

12. Kuo JR, Chou TJ, Chio CC. Coagulopathy as a parameter to predict the outcome in head injury patients- analysis of 61 cases. J ClinNeurosci. 2004 Sep; 11(7):710-714.

13. Salehpour F, Bazzazi AM, Porhomayon J, Nader ND. Correlation between coagulopathy and outcome in severe head trauma in neurointensive care and trauma units. J Crit Care. 2011 Aug; 26(4):352-356.

14. Hanes SD, Quarles DA, Boucher BA. Incidence and risk factors of thrombocytopenia in critically ill trauma patients. Ann Pharmacother. 1997 Mar; 31(3):285-289.

15. Chhabra G, Rangarajan K, Subramanian A, Agrawal D, Sharma S, Mukhopadhayay AK. Hypofibrinogenemia in isolated traumatic brain injury in Indian patients. Neurol India. 2010 Sep-Oct; 58(5):756-757.

16. Kumura E, Sato M, Fukuda A, Takemoto Y, Tanaka S, Kohama A. Coagulation disorders following acute head injury. ActaNeurochir (Wien). 1987; 85(1-2):23-28.

17. Miner ME, Kaufman HH, Graham SH, Haar FH, Gildenberg PL. Disseminated intravascular coagulation fibrinolytic syndrome following head injury in children: frequency and prognostic implications. J Pediatr. 1982 May; 100(5):687-691.

18. Selladurai BM, Vickneswaran M, Duraisamy S, Atan M. Coagulopathy in acute head injury-a study of its role as a prognostic indicator. Br J Neurosurg.1997 Oct; 11(5):398-404.

19. Greuters S, van den Berg A, Franschman G, Viersen VA, Beishuizen A, Peerdeman SM, Boer C; ALARM-BLEEDING investigators. Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury. J Crit Care. 2011; 15:R2. Epub 2011 Jan 5.

20. Cortiana M, Zagara G, Fava S, Seveso M. Coagulation abnormalities in patients with head injury. J Neurosurg Sci. 1986 July- Sep; 30(3):133-138.

21. Atraqchi Al AA. Prothrombin Time role in Head Injury and Intracranial Hematomas, a prospective study of 325 cases. J Al-Kindy Col Med. 2012; 8:54-57.

22. Subramaniam PC, Bogra J, Chandra G, Kumar A, Kohli M, Dasmana S, Srivastava P, Mishra KL. Coagulation profile as predictor of recovery status in patients of head injury. International J of Scientific and Innovative Research. 2013; 1(2):39-50.

23. Harhangi BS, Kompanje EJ, Leebeek FW, Maas AI. Coagulation disorders after traumatic brain injury. ActaNeurochir(Wien). 2008 Feb; 150(2):165-175.

24. Chhabra G, Sharma S, Subramanian A, Agrawal D, Sinha S, Mukhopadhyay AK. Coagulopathy as prognostic marker in acute traumatic brain injury. J Emerg Trauma Shock. 2013 July; 6(3):180-185.

25. MacLeod JB, Lynn M, McKenney MG, Cohn SM, Murtha M. Early coagulopathy predicts mortality in trauma. J Trauma. 2003 July; 55(1):39-44.

26. Kearney TJ, Bentt L, Grode M, Lee S, Hiatt JR, Shabot MM. Coagulopathy and catecholamines in severe head injury. J Trauma. 1992 May; 32(5):608-611.

27. Kaufman HH, Moake JL, Olson JD, Miner ME, duCret RP, Pruessner JL, Gildenberg PL. Delayed and recurrent intracranial hematomas related to disseminated intravascular clotting and fibrinolysis in head injury. Neurosurgery. 1980 Nov; 7(5):445-449.

28. May AK, Young JS, Butler K, Bassam D, Brady W. Coagulopathy in severe head closed head injury: is empiric therapy warranted? Am Surg.1997 March; 63(6):233-236.

29. Keller MS, Fendya DG, Weber TR. Glasgow Coma Scale predicts coagulopathy in pediatric trauma patients. Semin Pediatr Surg. 2001 Feb; 10(1):12-16.
Original Article