Objective To discuss the risk factors for coagulopathy in acute isolated traumatic brain injury (TBI). Methods A retrospective study was performed on 191 patients with acute isolated TBI hospitalized from July 2012 to June 2015. There were 70 patients with coagulopathy (coagulopathy group) and 121 patients without coagulopathy (control group). Age, gender, injury type, midline shift on CT and injury severity (Glasgow Coma Scale, GCS) were analyzed to identify the independent risk factors for coagulopathy using the logistic regression analysis. Correlation between the independent risk factors and coagulation indices was analyzed.  Results Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT were identified as the independent risk factors for coagulopathy(P<0.05，OR＞1 ) . Furthermore, injury severity and acute subdural hematoma were respectively associated with abnormalities of international normalized ratio (INR) and fibrinogen (Fg) (P<0.05 or P<0.01), intraventricular bleeding with abnormalities of prothrombin time (PT) and platelet count (PC) (P<0.01), and midline shift on CT with abnormalities of Fg and PC (P<0.05).  Conclusions Injury severity, acute subdural hematoma, intraventricular bleeding and midline shift on CT are independent risk factors for coagulopathy in patients with acute isolated TBI, and correlate with abnormalities of several coagulation indices. Changes in coagulation indices should be monitored accurately after TBI, and timely treatment of coagulopathy can improve the prognosis.