Analysis Of The Relationship Between The Changes Of Prothrombin And Platelet And The Risk Of Rebleeding In Acute Subdural Hematoma Caused By Trauma

ObjectiveTo study the role of prothrombin,plasminogen,international standardized ratio and platelet in acute subdural hematoma after the occurrence of acute subdural hematoma,to determine the correlation between the changes of coagulation-related factors and the risk of rebleeding after trauma.MethodsThe patients admitted to the Department of Neurosurgery of the Second Affiliated Hospital of Shenyang Medical College from January 2007 to December2022 were retrospectively analyzed,and the patients with acute subdural hematoma were confirmed by clinical and imaging indexes.the patients diagnosed with acute subdural hematoma were screened out and recorded the data of prothrombin,plasminogen,international standardized ratio and platelet.The results of head CT reexamination were compared with the changes of head CT on admission.According to the imaging signs of increased rebleeding,the patients were divided into rebleeding group and non-rebleeding group.The relationship between these factors and the risk of rebleeding was analyzed from the data of sex,age and coagulation related indexes.Univariate analysis and multi-factor Logistic regression analysis were used to analyze the data of the included indexes.Finally,the ROC curve of related risk factors was drawn to determine the sensitivity and specificity of risk factors and rebleeding risk.ResultsUnivariate analysis showed that age,sex,thrombin time and fibrinogen were not related to rebleeding,but prothrombin time,international standardized ratio,activated partial thrombin time and platelet level were all related to rebleeding.Multivariate Logistic regression analysis showed that prothrombin time(OR=1.497,P=0.005),international standardized ratio(OR=23.957,P=0.026)and activated partial thrombin time(OR=1.156,P=0.002)were risk factors for rebleeding,while platelet(OR=0.991,P=0.009)was a protective factor for rebleeding.After improving the ROC curve,we can see that the data of the three risk factors can predict the occurrence of ASDH rebleeding to a certain extent.The AUC of PT is 0.657,the best cut-off value is 13.25,the sensitivity is 60%,and the specificity is 73.3%.The AUC of INR is 0.615,the best cutoff value is 1.065,the sensitivity is 66%,the specificity is 58.3%,the AUC is 0.673,the best cutoff value is 31.60,the sensitivity is 42%,and the specificity is83.3%.If the risk indicators of the three blood coagulation factors are combined,the AUC is 0.727,the ability to predict the risk of rebleeding will be stronger than single-factor prediction.ConclusionThrough a retrospective analysis of the data of rebleeding group and non-bleeding group in patients with ASDH after craniocerebral injury,it was concluded that:1.The risk of rebleeding in patients with ASDH was not related to age,sex,TT and FIB(P>0.05);2.The risk of rebleeding in patients with ASDH was correlated with the levels of PT,INR,APTT and PLT in peripheral blood(P<0.05);3.When PT,INR and APTT increase,the risk of rebleeding in patients with ASDH will further increase,while when the PLT value increases,the risk of rebleeding in patients with ASDH will decrease to a certain extent,and when two or more of these four indexes change,it can clearly predict rebleeding or increase the amount of bleeding.