A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury

Nakae, Ryuta; Yokobori, Shoji; Takayama, Yusuke; Kanaya, Takahiro; Fujiki, Yu; Igarashi, Yutaka; Suzuki, Go; Naoe, Yasutaka; Fuse, Akira; Yokota, Hiroyuki

doi:10.1007/s00701-019-04010-3

Cited by 28 publications

(25 citation statements)

References 38 publications

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“…We evaluated 1543 cases with TBI managed from April 2007 to December 2018. Of these, 345, 405, and 523 cases (some of the cases overlap) were from our previous studies published in 2016, 2017, and 2019, respectively [ 7 , 8 , 9 ]. The mechanisms of injury were traffic accidents in 899 patients (58.3%), falls in 564 patients (36.5%), and other mechanisms in 80 patients (5.2%).…”

Section: Resultsmentioning

confidence: 99%

“…We retrospectively investigated demographic, clinical, and radiologic findings from 1543 consecutive patients with TBI admitted to the Critical Care Center of Nippon Medical School and Kawaguchi Municipal Medical Center from April 2007 to December 2018. Of these, 345, 405, and 523 cases were (some of the cases overlap) from our previous studies published in 2016, 2017 and 2019, respectively [ 7 , 8 , 9 ]. Patients diagnosed with severe TBI, defined previously as AIS-head ≥3 [ 4 , 5 , 7 ], with initial blood samples obtained ≤1 h after injury, were eligible.…”

Section: Methodsmentioning

confidence: 99%

“…The rationale of 75 y as a cutoff point was based on the definition of “elderly” by the Joint Committee of the Japan Gerontological Society and the Japan Geriatrics Society [ 10 ]. We assessed the propensity score by fitting a logistic regression model as a function of the patients’ demographic and clinical characteristics, including the following, which were previously reported to have the potential to affect coagulation/fibrinolytic parameters and the outcome in patients with severe TBI: Age [ 3 , 6 , 7 ]; sex; GCS score at admission [ 6 , 7 , 37 ]; the presence of ASDH, AEDH, TICH, and TSAH; AIS-head, face, chest, abdomen, extremities, and external [ 6 , 7 , 37 , 43 , 44 ]; ISS [ 6 , 37 , 43 , 44 ]; and the volume of FFP [ 8 , 45 , 46 ]. We evaluated the balance in baseline variables using standardized differences, in which an absolute value of <10% was considered as balanced [ 42 ].…”

Section: Methodsmentioning

confidence: 99%

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Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

Nakae

Fujiki

Takayama

et al. 2020

IJMS

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Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3–6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the “elderly group,” aged ≥75 y) and younger patients (the “non-elderly group,” aged 16–74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3–6 h post-injury, and D-dimer levels between admission and 3–6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

Nakae

Fujiki

Takayama

et al. 2020

IJMS

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“…When the fibrinogen level was < 2 g/L at arrival, a PICH progression was three-times more likely to occur. Nakae et al [26] revealed that among patients with TBI who did not receive a fresh frozen plasma transfusion, a fibrinogen level < 150 mg/dL at 3 h after injury was significantly associated with a higher duration of mechanical ventilation and lower GOS scores at discharge and 3 months after injury. From the CART analysis in the present study, we concluded that TBI patients in group B with normal APTT and decreased fibrinogen (≤ 120 mg/dL) had increased inhospital mortality, prolonged LOS in the ICU and hospital, and shortened ventilator-free days, ICU-free days, and hospital-free days than patients in group A, which indicated that fibrinogen was also an important coagulation parameter associated with poor outcome.…”

Section: Discussionmentioning

confidence: 99%

Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study

You

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Coagulopathy in adult patients with traumatic brain injury (TBI) is strongly associated with unfavorable outcomes. However, few reports focus on pediatric TBI-associated coagulopathy. Methods We retrospectively identified children with Glasgow Coma Scale ≤ 13 in a tertiary pediatric hospital from April 2012 to December 2019 to evaluate the impact of admission coagulopathy on their prognosis. A classification and regression tree (CART) analysis using coagulation parameters was performed to stratify the death risk among patients. The importance of these parameters was examined by multivariate logistic regression analysis. Results A total of 281 children with moderate to severe TBI were enrolled. A receiver operating characteristic curve showed that activated partial thromboplastin time (APTT) and fibrinogen were effective predictors of in-hospital mortality. According to the CART analysis, APTT of 39.2 s was identified as the best discriminator, while 120 mg/dL fibrinogen was the second split in the subgroup of APTT ≤ 39.2 s. Patients were stratified into three groups, in which mortality was as follows: 4.5 % (APTT ≤ 39.2 s, fibrinogen > 120 mg/dL), 20.5 % (APTT ≤ 39.2 s and fibrinogen ≤ 120 mg/dL) and 60.8 % (APTT > 39.2 s). Furthermore, length-of-stay in the ICU and duration of mechanical ventilation were significantly prolonged in patients with deteriorated APTT or fibrinogen values. Multiple logistic regression analysis showed that APTT > 39.2 s and fibrinogen ≤ 120 mg/dL was independently associated with mortality in children with moderate to severe TBI. Conclusions We concluded that admission APTT > 39.2 s and fibrinogen ≤ 120 mg/dL were independently associated with mortality in children with moderate to severe TBI. Early identification and intervention of abnormal APTT and fibrinogen in pediatric TBI patients may be beneficial to their prognosis.

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“…Fresh frozen plasma (FFP) is frequently administered in patients with TBI to counteract hemostatic abnormalities and restore fibrinogen and other coagulation factors. 88 Administration of FFP is recommended for TBI patients with acute traumatic coagulopathy as defined by an INR > 1.4, 89 aPTT > 35 seconds, and/or fibrinogen < 150 mg/dL. 88 In a porcine model, administration of FFP has been shown to reduce the degree of neurologic impairment and time to recovery, suggesting a potential interaction between coagulation and neuroregulatory pathways.…”

Section: Plasmamentioning

confidence: 99%

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Anderson

Farrell

Rowell

2021

Semin Thromb Hemost

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Posttraumatic coagulopathy involves disruption of both the coagulation and fibrinolytic pathways secondary to tissue damage, hypotension, and inflammatory upregulation. This phenomenon contributes to delayed complications after traumatic brain injury (TBI), including intracranial hemorrhage progression and systemic disseminated intravascular coagulopathy. Development of an early hyperfibrinolytic state may result in uncontrolled bleeding and is associated with increased mortality in patients with TBI. Although fibrinolytic assays are not routinely performed in the assessment of posttraumatic coagulopathy, circulating biomarkers such as D-dimer and fibrin degradation products have demonstrated potential utility in outcome prediction. Unfortunately, the relatively delayed nature of these tests limits their clinical utility. In contrast, viscoelastic tests are able to provide a rapid global assessment of coagulopathy, although their ability to reliably identify disruptions in the fibrinolytic cascade remains unclear. Limited evidence supports the use of hypertonic saline, cryoprecipitate, and plasma to correct fibrinolytic disruption; however, some studies suggest more harm than benefit. Recently, early use of tranexamic acid in patients with TBI and confirmed hyperfibrinolysis has been proposed as a strategy to further improve clinical outcomes. Moving forward, further delineation of TBI phenotypes and the clinical implications of fibrinolysis based on phenotypic variation is needed. In this review, we summarize the clinical aspects of fibrinolysis in TBI, including diagnosis, treatment, and clinical correlates, with identification of targeted areas for future research efforts.

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A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury

Cited by 28 publications

References 38 publications

Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

Relationship between admission coagulopathy and prognosis in children with traumatic brain injury: a retrospective study

Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

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