Wada T et al. – The retrospective study hypothesized that the outcome of the patients is affected by the disseminated intravascular coagulation (DIC) with hyperfibrinolysis caused by hypoperfusion, during the early stage of isolated traumatic brain injury (iTBI). The results concluded that hyperfibrinolysis is not caused by low blood pressure–induced tissue hypoperfusion.

Methods

• A total of 92 patients with iTBI were divided into DIC and non–DIC groups using the Japanese Association Acute Medicine DIC scoring system. Further subdivision was performed with and without the presence of hyperfibrinolysis.
• Parameters measured and assessed include platelet count, global markers of coagulation, fibrinolysis, systemic inflammatory response syndrome (SIRS), organ dysfunction (assessed by the Sequential Organ Failure Assessment score), and tissue hypoperfusion (assessed by the lactate levels).
In addition, the transfusion volume was also evaluated. The primary outcome measure was all–cause hospital mortality.

Results

• Compared to non–DIC patients, consumption coagulopathy, lower antithrombin levels, higher fibrin/ fibrinogen degradation products and D–dimer levels were observed in DIC patients.
• Compared to non–DIC patients, DIC patients developed SIRS along with organ dysfunction and required higher blood transfusion volumes, leading to worse outcomes.
• In addition, changes were more prominent in DIC patients with hyperfibrinolysis.
• There was no difference in the mean blood pressure of patients with or without DIC.
• Hypoperfusion and lactate levels were excluded as independent predictors of hyperfibrinolysis.