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Effectiveness of Administration of Fibrinogen Concentrate as Prevention of Hypofibrinogenemia in Patients with Traumatic Brain Injury with a Higher Risk for Severe Hyperfibrinolysis: Single Center Before-and-After Study

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Abstract

Background

Coagulopathy is often observed in severe traumatic brain injury (sTBI), and hyperfibrinolysis (HF) is associated with a poor prognosis. Although the efficacy of fibrinogen concentrate (FC) in multiple trauma has been reported, its efficacy in sTBI is unclear. Therefore, we delineated severe HF risk factors despite fresh frozen plasma transfusion. Using these risk factors, we defined high-risk patients and determined whether FC administration to this group improved fibrinogen level.

Methods

In the first part of this study, successive adults with sTBI treated at our hospital between April 2016 and March 2019 were reviewed. Patients underwent transfusion as per our conventional protocol and were divided into two groups based on whether fibrinogen levels of ≥ 150 mg/dL were maintained 3–6 h after arrival to delineate the risk factors of severe HF. In the second part of the study, we conducted a before-and-after study in patients with sTBI who were at a higher risk for severe HF (presence of at least one of the risk factors identified in the first part of the study), comparing those treated with FC between April 2019 and March 2021 (FC group) with those treated with conventional transfusion before FC between April 2016 and March 2019. The primary outcome was maintenance of fibrinogen levels, and the secondary outcome was 30-day mortality.

Results

In the first part of the study, 78 patients were included. Twenty-three patients did not maintain fibrinogen levels ≥ 150 mg/dL. A D-dimer level on arrival > 50 μg/mL, a fibrinogen level on arrival < 200 mg/dL, depressed skull fracture, and multiple trauma were severe HF risk factors. In the second part, compared with 46 patients who were identified as being at high risk for severe HF but were not administered FC (non-FC group), fibrinogen levels ≥ 150 mg/dL 3–6 h after arrival were maintained in 14 of 15 patients in the FC group (odds ratio: 0.07; 95% confidence interval: 0.01–0.59). Although there were significant differences in fibrinogen levels, no significant differences were observed in terms of 30-day mortality between the groups.

Conclusions

Coagulation abnormalities on arrival, severe skull fracture, and multiple trauma are severe HF risk factors. FC administration may contribute to rapid correction of developing hypofibrinogenemia.

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Source of Support

Nothing to disclose.

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Authors and Affiliations

  1. Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc, 2-4-1, Ohashi, Ritto, Shiga, 520-3046, Japan

    Gaku Fujiwara

  2. Department of Neurosurgery, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan

    Gaku Fujiwara, Mamoru Murakami, Daisuke Maruyama & Nobukuni Murakami

  3. Department of Neurosurgery, Tanabe Central Hospital, Kyoto, Japan

    Mamoru Murakami

  4. Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, Kyoto, Japan

    Wataru Ishii & Ryoji Iizuka

  5. Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan

    Daisuke Maruyama & Naoya Hashimoto

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  1. Gaku Fujiwara
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  2. Mamoru Murakami
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  7. Naoya Hashimoto
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Contributions

Conception and design of the study: GF. Analysis and interpretation of data: GF and MM. Collection and assembly of data: GF, MM, and WI. Drafting of the article: GF. Critical revision of the article for important intellectual content: MM, WI, DM, RI, NM, and NH. Final approval of the article: NM and NH.

Corresponding author

Correspondence to Gaku Fujiwara.

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This study was approved by institutional review board of the Japanese Red Cross Society Kyoto Daini Hospital and received ethical clearance (approval ID: Sp2021-20).

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Fujiwara, G., Murakami, M., Ishii, W. et al. Effectiveness of Administration of Fibrinogen Concentrate as Prevention of Hypofibrinogenemia in Patients with Traumatic Brain Injury with a Higher Risk for Severe Hyperfibrinolysis: Single Center Before-and-After Study. Neurocrit Care 38, 640–649 (2023). https://doi.org/10.1007/s12028-022-01626-9

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