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Acta Neurochirurgica
Published in: Acta Neurochirurgica 9/2019

01-09-2019 | Central Nervous System Trauma | Original Article - Brain trauma

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

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

Published in: Acta Neurochirurgica | Issue 9/2019

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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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Metadata
Title
A retrospective study of the effect of fibrinogen levels during fresh frozen plasma transfusion in patients with traumatic brain injury
Authors
Ryuta Nakae
Shoji Yokobori
Yasuhiro Takayama
Takahiro Kanaya
Yu Fujiki
Yutaka Igarashi
Go Suzuki
Yasutaka Naoe
Akira Fuse
Hiroyuki Yokota
Publication date
01-09-2019
Publisher
Springer Vienna
Published in
Acta Neurochirurgica / Issue 9/2019
Print ISSN: 0001-6268
Electronic ISSN: 0942-0940
DOI
https://doi.org/10.1007/s00701-019-04010-3

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