Invited Commentary

E. Thomas Chappell, MD
Arch Surg. 1996;131(9):928. doi:10.1001/archsurg.1996.01430210026005.
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This review attempts to further characterize what is a daunting and often overlooked contributor to morbidity and mortality in patients with severe head injury. The "blossoming" of cerebral contusions that leads to intractable intracranial hypertension and often death or severe disability is frequently attributed to this phenomenon on rounds, but few attempts have been made at scientific analysis with the intent of possibly defining a useful therapeutic approach to the problem. While this study only begins to further delineate the nature of coagulopathy associated with head injury, it may help set the stage for prospective studies that might include or lead to potential therapeutic interventions.

The authors reviewed the literature correlating coagulation disorders with severity, outcome, and systemic complications in patients with head injury. Their work better defines the temporal patterns of laboratory evidence of coagulopathy after head injury. Investigators may now endeavor to prospectively analyze potential therapeutic options that


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