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

  • Original Article - Brain trauma
  • Published:
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Abstract

Background

The association between traumatic brain injury (TBI) and coagulopathy is well established. While coagulopathy prophylaxis in TBI involves replenishing coagulation factors with fresh frozen plasma (FFP), its effectiveness is controversial. We investigated the relationship between plasma fibrinogen concentration 3 h after initiating FFP transfusion and outcomes and evaluated the correlation with D-dimer levels at admission.

Methods

We retrospectively examined data from 380 patients with severe isolated TBI with blood samples collected a maximum of 1 h following injury. Plasma fibrinogen and D-dimer concentrations were obtained at admission, and plasma fibrinogen concentration was again assessed 3–4 h following injury. The patients were divided into two groups based on whether or not they received FFP transfusion. Patients were also divided into subgroups according their fibrinogen level: ≥ 150 mg/dL (high-fibrinogen subgroup) or < 150 mg/dL (low-fibrinogen subgroup) 3 h after injury. Demographic, clinical, radiological and laboratory data were compared between these subgroups.

Results

Glasgow Outcome Scale (GOS) scores at discharge and 3 months after injury were significantly lower in the FFP transfusion group than in the FFP non-transfusion group. Among patients who received FFP, GOS scores at discharge and 3 months after injury were significantly higher in the high-fibrinogen subgroup than in the low-fibrinogen subgroup. Elevated admission D-dimer predicted subsequent fibrinogen decrease.

Conclusions

In FFP transfusion, fibrinogen level ≥ 150 mg/dL 3 h after injury was associated with better outcomes in TBI patients. Assessing the admission D-dimer and tracking the fibrinogen are crucial for optimal coagulopathy prophylaxis in TBI patients.

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Acknowledgements

We thank Libby Cone, MD, MA, from DMC Corp. (www.dmed.co.jp) for editing drafts of this manuscript.

Funding

This study was supported in part by a medical research grant on traffic accidents from the General Insurance Association of Japan (#18-1-49). The funders had no role in the execution of this study or interpretation of the results.

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Authors and Affiliations

  1. Department of Emergency and Critical Care Medicine, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan

    Ryuta Nakae, Shoji Yokobori, Yasuhiro Takayama, Takahiro Kanaya, Yutaka Igarashi, Akira Fuse & Hiroyuki Yokota

  2. Emergency and Critical Care Center, Kawaguchi Municipal Medical Center, Saitama, Japan

    Yu Fujiki, Go Suzuki & Yasutaka Naoe

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  1. Ryuta Nakae
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Correspondence to Ryuta Nakae.

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The authors declare that they have no conflict of interest.

IRB approval

This study was approved by the hospital’s Institutional Review Board (approval #2018-27).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Retrospective cohort study.

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Nakae, R., Yokobori, S., Takayama, Y. et al. A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury. Acta Neurochir 161, 1943–1953 (2019). https://doi.org/10.1007/s00701-019-04010-3

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