Highlights
- •The current study was conducted to evaluate both efficacy and safety of fibrinogen administration in severe traumatic head injury (TBI), and concurrent hypofibrinogenemia.
- •Fibrinogen administration controls hematoma expansion and improves GCS recovery and GOSE in severe TBI.
Abstract
Aim
This study was conducted to evaluate clinical outcomes after fibrinogen administration
in hypofibrinogenemia following severe traumatic brain injury.
Background
Post traumatic coagulopathy (PTC) is a common but devastating medical condition in
patients with severe head injury. Hypofibrinogenemia is considered as an indicator
for poor clinical outcomes in traumatic brain injury (TBI).
Methods
In this randomized clinical trial (RCT), primarily 137 patients with severe traumatic
brain injury (Glasgow coma scale score: GCS < 9) were enrolled. Thereafter, their
plasma fibrinogen level was measured. The patients with primary hypofibrinogenemia
(<200 mg/dL) with no concurrent coagulopathy were randomly allocated into fibrinogen-receiving
(n = 50) and control (n = 54) groups. P-value < 0.05 was considered as statistically
significant.
Results
Seventy-one patients were analyzed in the final step of the study. The mean value
for age in fibrinogen and control groups was 25.64 ± 10.71 and 28.91 ± 12.25 years
old, respectively. Male – female patients in both groups were equally distributed.
In the fibrinogen receiving group, GCS scores were significantly higher after 24,
48, and 72 h compared to the control group (p = 0.000). Hematoma expansion was better
controlled in the fibrinogen receiving group (p = 0.000). Notably, the number needed
to treat (NNT) for fibrinogen infusion and hematoma expansion control was 2.3. Glasgow
outcome scale-extended (GOSE) was significantly better in the fibrinogen group (p = 0.25).
Multiple regression tests showed intracerebral hematoma (ICH) and severe brain edema
had the most detrimental effect on GOSE outcomes. The need for cranial surgery, hospital
stay duration, mechanical ventilator dependency, in hospital and 90-day post discharge
mortality rates were similar in both study groups.
Conclusion
In severe TBI, hypofibrinogenemia correction (>200 mg/dL) could improve GOSE, GCS
score progression within 3 days after primary head injury and hematoma expansion controllability.
Keywords
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Article info
Publication history
Accepted:
May 15,
2022
Received:
December 20,
2021
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
