The effects of intravascular coagulation and microthrombosis on cerebral perfusion after brain trauma

Abstract

Derangements in coagulation occur frequently after traumatic brain injury (TBI) and are associated with an increased risk of mortality or poor outcome. The coagulopathy after TBI is likely a variant of disseminated intravascular coagulation (DIC), composed of both hypocoagulable and hypercoagulable states with resultant hemorrhagic and thrombotic phenotypes. Much attention has been paid to the hemorrhagic phenotype of intravascular coagulation (IC) due to its association with progression of hemorrhagic injury. However, the coagulopathy after TBI also results in thrombosis, which may be responsible for compromised cerebral perfusion and thromboembolic phenomena as well as progression of injury. This chapter reviews the literature on intravascular coagulation after TBI, examines the effects of intravascular coagulation on microthrombosis, cerebral blood flow (CBF), and progression of injury, and reviews putative pathogenetic mechanisms.