[Haemostatic activation in head injury]. / Activación hemostática en el traumatismo creoencefálico.

A relationship between Central Nervous System and coagulation has been known since the work by Goodnight et al5. When an encephalic injury occurs tissue damage causes the release of thromboplastin-related products, mainly the Tissular Factor. This release produces an activation of the coagulation system specially through its extrinsic path. With this physiopathologic basis we attempt to improve the knowledge of this relation by performing a prospective study at the Intensive Care Unit of our Hospital. The study included 67 patients with cranioencephalic trauma alone, with an average Glasgow coma scale score of 10 and a control group consisting of 40 healthy subjects. Two peripheral vein blood extractions were performed, at admission and 24 hours later. Global coagulation parameters (prothrombin time, activated partial thromboplastin time, platelet count and fibrinogen), hypercoagulability markers (prothrombin fragments F1+2 and thrombin-antithrombin complex (TAT)) and thrombolisis markers (D-dimer) were determined. Our results show that early after head trauma an increase in fragments F1+2, TAT and Ddimer occur. After the first 24 hours a significant decrease in hypercoagulability markers levels is detected. Modification of the global coagulation parameters was also detected. In conclusion, early after a cranioencephalic trauma a simultaneous state of hypercoagulability and thrombolysis occur which may have the purpose of improving the hemostatic balance.

[Therapeutic attitude, evolution and prognosis of the cerebral hemorrhages of patients in dicumarinic treatment, in function of their supra or infratentorial localization]. / Actitud terapéutica, evolución y pronóstico de la hemorragia cerebral, según la localización supra o infratentorial, de pacientes en tratamiento dicumarínico.

INTRODUCTION: The anticoagulants are drugs with possible serious secondary effects, being one of the most serious the appearance of intracraneal hemorrhages, being able to vary the clinical course as they were hemorrhages in the deep supratentorial compartment (ST) or in the infratentorial (IT). OBJECTIVES: Compare the therapeutic attitude, the evolution and the prognostic of the cerebral hemorrhages in patient with warfarin treatment, in function of their localization ST or IT. PATIENTS AND METHODS: Descriptive and retrospective analysis of 42 patients; in 28 of the cases (66,6%) the localization was ST, and in 14 of the patients (33,3%) the localization was IT. We study risk vascular factors, age and the sex of the patients, the volume of the hemorrhage, the initial clinical state of the patients, the therapeutic attitude, the average stay and the mortality. As statistical tools, the t of Student and the c2 test were used, demanding a confidence interval of 95%. RESULTS: The factors of cardiovascular risk of our serie were similar to the existent ones in other studies. The hemorrhages IT are more frequent in women, existing significant differences in the age among sexes in function of the localization. 100% of the hemorrhages IT exceeded the therapeutic INR, in front of 39% of the ST. A bigger half stay is also demonstrated in the ST hemorrhages so much in the surviving as in the exitus. Statistical significance was not reached in the rest of the studied parameters. CONCLUSIONS: The presence of a INR that surpasses the therapeutic is an indicator of hemorrhage risk IT, in patient dicumarinic drawees, and that in this same subgrup, the stays stockings are sensibly inferior, in all the subgrups (medical treatment and surgical treatment). Also the feminine sex has a bigger incidence of processes ST, with a smaller presentation age.

Actitud terapéutica, evolución y pronóstico de la hemorragia cerebral, según la localización supra o infratentorial, de pacientes en tratamiento dicumarínico / Therapeutic attitude, evolution and prognostic of the cerebral hemorrhages of patients in dicumarinic treatment, in function of their supra or infratentorial localization

Introducción. La hemorragia intracraneal es uno de los efectos secundarios más graves de los anticoagulantes; el curso clínico puede variar según se trate de hemorragias supratentoriales (ST) profundas o infratentoriales (IT). Objetivo. Comparar la actitud terapéutica, la evolución y el pronóstico de los pacientes con hemorragia cerebral y tratamiento dicumarínico según la localización sea ST o IT. Pacientes y métodos. Análisis descriptivo y retrospectivo de 42 pacientes con hemorragia cerebral, ST profunda en 28 casos (66,6 por ciento), IT en los restantes 14 (33,3 por ciento). Estudiamos los factores de riesgo vascular, la edad, el sexo, el volumen de la hemorragia, el estado clínico inicial, la actitud terapéutica, la estancia media y la mortalidad. Como herramientas estadísticas empleamos la t de Student y el test de c2, con un intervalo de confianza del 95 por ciento. Resultados. Los factores de riesgo cardiovascular de nuestra serie son similares a los que presentan otros estudios. La hemorragia IT es más frecuentes en mujeres; existe una diferencia significativa en la edad entre sexos en función de la localización. Todos los pacientes con hemorragia IT excedían el INR terapéutico mientras que sólo lo hacía el 39 por ciento de los casos con hemorragia ST. La estancia media fue más prolongada entre los pacientes con hemorragia ST, tanto en los pacientes que sobrevivieron como entre los que fallecieron. No se alcanzó significación estadística en el resto de los parámetros estudiados. Conclusiones. La presencia de un INR que sobrepase el terapéutico es un indicador de riesgo para la hemorragia IT en pacientes en tratamiento dicumarínico. La estancia media del grupo IT es más corta (tanto en el subgrupo de pacientes que recibió tratamiento médico como en el que recibió tratamiento quirúrgico) que la del grupo ST. El sexo femenino tiene una mayor incidencia de procesos ST y una menor edad de presentación (AU)