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Indian Journal of Neurotrauma 2016; 13(01): 011-014
DOI: 10.1055/s-0036-1583263
Original Article
Neurotrauma Society of India

The Incidence and Risk Factors for Hypofibrinogenemia in Patients with Traumatic Brain Injury Undergoing Surgery

Sonia Bansal
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Rohini M. Surve
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Nitin Manohar
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Bhadri V. Narayan
1   Department of Neuroanaesthesia, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
Mariamma Philip
2   Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
,
B. Indira Devi
3   Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
› Author Affiliations
Further Information

Publication History

04 December 2015

17 March 2016

Publication Date:
19 April 2016 (online)

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Abstract

Fibrinogen is the primary substrate of coagulation. Fibrinogen depletion occurs in acute traumatic coagulopathy and is associated with unfavorable outcomes. Fibrinogen levels also decrease following traumatic brain injury (TBI) due to hypothermia, acidosis, and hypoperfusion leading to hyperfibrinolysis. This study was conducted to identify risk factors and the incidence of hypofibrinogenemia following TBI and also its effect on perioperative complications and postoperative outcome. A total of 51 adult patients with TBI were included in the study, and 33.3% of them had hypofibrinogenemia. Patients with low fibrinogen levels had lower preoperative Glasgow Coma Score (GCS), had associated derangement of international normalized ratio (INR), received more blood transfusions, and had lower discharge GCS compared with those with normal fibrinogen levels. Patients with hypofibrinogenemia had higher incidence of repeat surgery. In conclusion, hypofibrinogenemia occurs commonly after TBI and is associated with poor outcomes.

Keywords

traumatic brain injury - hypofibrinogenemia - coagulopathy

Note

This article was presented at 24th Annual National Conference of Neurotrauma Society of India, Bengaluru, from August 21 to 23, 2015, and had received the Alfred Trauma Research Development award for the year 2014–2015. There are no conflict of interest or financial disclosures to be made.


 

  • References

  • 1 Harhangi BS, Kompanje EJ, Leebeek FW, Maas AI. Coagulation disorders after traumatic brain injury. Acta Neurochir (Wien) 2008; 150 (2) 165-175 , discussion 175
    CrossrefPubMedSearch in Google Scholar
  • 2 Greuters S, van den Berg A, Franschman G , et al; ALARM-BLEEDING investigators. Acute and delayed mild coagulopathy are related to outcome in patients with isolated traumatic brain injury. Crit Care 2011; 15 (1) R2 ; doi:10.1186/cc9399
    CrossrefPubMedSearch in Google Scholar
  • 3 Martini WZ, Holcomb JB. Acidosis and coagulopathy: the differential effects on fibrinogen synthesis and breakdown in pigs. Ann Surg 2007; 246 (5) 831-835
    CrossrefPubMedSearch in Google Scholar
  • 4 Rourke C, Curry N, Khan S , et al. Fibrinogen levels during trauma hemorrhage, response to replacement therapy, and association with patient outcomes. J Thromb Haemost 2012; 10 (7) 1342-1351
    CrossrefPubMedSearch in Google Scholar
  • 5 Chhabra G, Rangarajan K, Subramanian A, Agrawal D, Sharma S, Mukhopadhayay AK. Hypofibrinogenemia in isolated traumatic brain injury in Indian patients. Neurol India 2010; 58 (5) 756-757
    CrossrefPubMedSearch in Google Scholar
  • 6 Cotton BA, Harvin JA, Kostousouv V , et al. Hyperfibrinolysis at admission is an uncommon but highly lethal event associated with shock and prehospital fluid administration. J Trauma Acute Care Surg 2012; 73 (2) 365-370 , discussion 370
    CrossrefPubMedSearch in Google Scholar
  • 7 Jackman RP, Utter GH, Muench MO , et al. Distinct roles of trauma and transfusion in induction of immune modulation after injury. Transfusion 2012; 52 (12) 2533-2550
    CrossrefPubMedSearch in Google Scholar
  • 8 Kimura Y, Kimura S, Sumita S, Yamakage M. Predictors of hypofibrinogenemia in blunt trauma patients on admission. J Anesth 2015; 29 (2) 242-248
    CrossrefPubMedSearch in Google Scholar
  • 9 Inaba K, Karamanos E, Lustenberger T , et al. Impact of fibrinogen levels on outcomes after acute injury in patients requiring a massive transfusion. J Am Coll Surg 2013; 216 (2) 290-297
    CrossrefPubMedSearch in Google Scholar