Coagulopathy is a known sequela of traumatic brain injury (TBI) and can lead to increased morbidity and mortality. Platelet dysfunction has been identified as one of several etiologies of coagulopathy following TBI and has been associated with poor outcomes. Regardless of whether the platelet dysfunction occurs as a direct consequence of the injury or because of pre-existing medical comorbidities or medication use, accurate detection and monitoring of response to therapy is key to optimal patient care. Platelet transfusion has been proposed as a potential therapeutic intervention to treat platelet dysfunction, with several studies using platelet function assays to monitor response. The development of increasingly precise diagnostic testing is providing enhanced understanding of the specific derangement in the hemostatic process, allowing clinicians to provide patient-specific treatment plans. There is wide variability in the currently available literature on the incidence and clinical significance of platelet dysfunction following TBI, which creates challenges with developing evidence-based management guidelines. The relatively high prevalence of platelet inhibitor therapy serves as an additional confounding factor. In addition, the data are largely retrospective in nature. We performed a literature review to provide clarity on this clinical issue. We reviewed 348 abstracts, and included 97 manuscripts in our final literature review. Based on the currently available research, platelet dysfunction has been consistently demonstrated in patients with moderate-severe TBI. We recommend the use of platelet functional assays to evaluate patients with TBI. Platelet transfusion directed at platelet dysfunction may lead to improved clinical outcome. A randomized trial guided by implementation science could improve the applicability of these practices.

中文翻译：

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创伤性脑损伤后的血小板功能障碍：综述

凝血病是创伤性脑损伤 (TBI) 的已知后遗症，可导致发病率和死亡率增加。血小板功能障碍已被确定为 TBI 后凝血障碍的几种病因之一，并且与不良结果相关。无论血小板功能障碍是由于损伤的直接后果还是由于先前存在的医学合并症或药物使用而发生，准确检测和监测对治疗的反应是优化患者护理的关键。血小板输注已被提议作为治疗血小板功能障碍的潜在治疗干预措施，有几项研究使用血小板功能测定来监测反应。越来越精确的诊断测试的发展正在增强对止血过程中特定紊乱的理解，允许临床医生提供针对患者的治疗计划。目前关于 TBI 后血小板功能障碍的发生率和临床意义的文献存在很大差异，这给制定循证管理指南带来了挑战。血小板抑制剂治疗的相对高流行率是一个额外的混杂因素。此外，这些数据在很大程度上是回顾性的。我们进行了文献综述，以明确这一临床问题。我们审查了 348 篇摘要，并在我们的最终文献审查中纳入了 97 篇手稿。根据目前可用的研究，中重度 TBI 患者一直存在血小板功能障碍。我们建议使用血小板功能测定来评估 TBI 患者。针对血小板功能障碍的血小板输注可能会改善临床结果。以实施科学为指导的随机试验可以提高这些实践的适用性。