title: Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury.
abstract: Traumatic brain injury (TBI) has long been associated with coagulopathy; however, the time course of coagulation/fibrinolytic parameters in the acute phase of TBI remains unclear. The purpose of the study was to analyze the time course of coagulation/fibrinolytic parameters in the acute phase of TBI and to elucidate parameter relationships to prognosis. We retrospectively evaluated 234 patients with severe isolated TBI with initial blood samples obtained no more than 1 h after injury. Platelet count, prothrombin time, activated partial thromboplastin time (aPTT), plasma levels of fibrinogen, and D-dimer were measured on arrival in the emergency department and 3, 6, and 12 h after injury. Multivariate logistic regression analysis was performed to identify risk factors for poor prognosis at each time point. From hospital admission to 12 h after injury, an elevated D-dimer level was a significant negative prognostic indicator (admission: p < 0.0001; 3 h after injury: p = 0.0005; 6 h after injury: p = 0.005; 12 h after injury: p = 0.0009). An upward trend of aPTT on admission and 3 h after injury was also a significant negative prognostic indicator (admission: p = 0.0011; 3 h after injury: p = 0.013). On multivariate logistic regression analysis, which included all initial variables, independent risk factors for poor prognosis included older age (p = 0.0005), low Glasgow Coma Scale score (p < 0.0001), high Abbreviated Injury Score (p = 0.015), aPTT >30.2 sec (p = 0.019), and elevated D-dimer level (p = 0.0005). We concluded that D-dimer is the best coagulation/fibrinolytic parameter to monitor for prediction of outcome.
authors.affiliation: 1 Emergency and Critical Care Center, Kawaguchi Municipal Medical Center , Saitama, Japan .
authors.forename: Ryuta
authors.initials: R
authors.lastname: Nakae
authors.affiliation: 2 Department of Emergency and Critical Care Medicine, Nippon Medical School , Tokyo, Japan .
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takayama
authors.affiliation: 2 Department of Emergency and Critical Care Medicine, Nippon Medical School , Tokyo, Japan .
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kuwamoto
authors.affiliation: 1 Emergency and Critical Care Center, Kawaguchi Municipal Medical Center , Saitama, Japan .
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Naoe
authors.affiliation: 2 Department of Emergency and Critical Care Medicine, Nippon Medical School , Tokyo, Japan .
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Sato
authors.affiliation: 2 Department of Emergency and Critical Care Medicine, Nippon Medical School , Tokyo, Japan .
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood*; D001777:Blood Coagulation / Q000502:physiology; D001778:Blood Coagulation Disorders / Q000209:etiology; D000070642:Brain Injuries, Traumatic / Q000097:blood* / Q000150:complications*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010976:Platelet Count; D011379:Prognosis; D011517:Prothrombin Time; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D005340:Fibrinogen
keywords: D-dimer; coagulopathy; fibrinolysis; prognosis; traumatic brain injury