Age-related differences in fibrinolytic parameters in patients with acute traumatic brain injury

Abstract

Background:Coagulopathy and old age have been associated with poor outcomes in traumatic brain injury (TBI) patients; however, the relationships of coagulopathy and age with the acute phase of TBI remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more severe in older patients in the acute phase of TBI and may explain, in part, their poor outcome.Methods:We analyzed the relationship between coagulation/fibrinolytic parameters and age in the acute phase of TBI by retrospectively evaluating 274 patients with initial blood samples obtained no more than 1 hour after injury. Measurement of platelet count, prothrombin time, activated partial thromboplastin time, plasma levels of fibrinogen, and D-dimer was done in the emergency department on arrival as well as 3, 6, and 12 hours following injury. Values were compared between patients aged 16–55 years (group 1) and those aged older than 55 years (group 2) with an Abbreviated Injury Score (AIS)-head of 3–5 to identify any relationship between these parameters and age.Results:When groups 1 and 2 were matched for AIS-head, plasma levels of D-dimer in group 2 were significantly higher than those in group 1 from hospital admission to 12 hours after injury. The Glasgow Outcome Scale scores at 3 months post-injury of group 2 with AIS 4 and 5 were significantly lower than those of group 1 (both P < 0.0001).Conclusions:Fibrinolytic abnormalities are more severe in older acute-phase TBI patients, which may be a factor associated with their poor prognosis.

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

“…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%).…”

“…Several recent papers have reported the time-course of coagulation and fibrinolytic variables in TBI in its acute phase [ 7 , 9 , 36 , 37 ]. We reported that the plasma levels of D-dimer on admission were higher in TBI patients with a poor outcome than those with a good outcome [ 7 ].…”

“…We reported that the plasma levels of D-dimer on admission were higher in TBI patients with a poor outcome than those with a good outcome [ 7 ]. Furthermore, we also showed that the plasma levels of D-dimer were higher in TBI patients aged >55 y than those aged 16–55 y [ 9 ]. In both studies, however, there were no differences in fibrinogen concentration on admission between patients with a good outcome and those with a poor outcome, and between patients aged > 55y and those aged 16–55 y.…”

“…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.…”

Tranexamic acid for significant traumatic brain injury (The CRASH-3 trial): Statistical analysis plan for an international, randomised, double-blind, placebo-controlled trial

“…There is evidence that fibrinolytic activation following TBI is greater in older patients 26 . For this reason, we will examine the effect of tranexamic acid on head injury death stratified by age.…”