Age-Related Differences in the Time Course of Coagulation and Fibrinolytic Parameters in Patients with Traumatic Brain Injury

• Published in: International journal of molecular sciences 2020-08, Vol.21 (16), p.5613
• Main Authors: Nakae, Ryuta, Fujiki, Yu, Takayama, Yasuhiro, Kanaya, Takahiro, Igarashi, Yutaka, Suzuki, Go, Naoe, Yasutaka, Yokobori, Shoji
• Format: Article
• Language: English
• Subjects: Abnormalities; Adolescent; Adult; Age; Age Factors; Aged; Blood Coagulation - genetics; blood coagulation disorders; brain injuries; Brain Injuries, Traumatic - blood; Brain Injuries, Traumatic - genetics; Brain Injuries, Traumatic - pathology; Coagulation; Cohort Studies; Female; Fibrin; Fibrin - genetics; Fibrin - metabolism; Fibrinogen; Fibrinogen - genetics; Fibrinogen - metabolism; Fibrinolysis - genetics; Humans; Injury analysis; Injury prevention; Injury Severity Score; Male; Medical schools; Middle Aged; Older people; Plasma; Risk analysis; Risk factors; Trauma; traumatic; Traumatic brain injury; Young Adult
• ISSN: 1422-0067; 1661-6596; 1422-0067
• DOI: 10.3390/ijms21165613

Coagulopathy and older age are common and well-recognized risk factors for poorer outcomes in traumatic brain injury (TBI) patients; however, the relationships between coagulopathy and age remain unclear. We hypothesized that coagulation/fibrinolytic abnormalities are more pronounced in older patients and may be a factor in poorer outcomes. We retrospectively evaluated severe TBI cases in which fibrinogen and D-dimer were measured on arrival and 3-6 h after injury. Propensity score-matched analyses were performed to adjust baseline characteristics between older patients (the "elderly group," aged ≥75 y) and younger patients (the "non-elderly group," aged 16-74 y). A total of 1294 cases (elderly group: 395, non-elderly group: 899) were assessed, and propensity score matching created a matched cohort of 324 pairs. Fibrinogen on admission, the degree of reduction in fibrinogen between admission and 3-6 h post-injury, and D-dimer levels between admission and 3-6 h post-injury were significantly more abnormal in the elderly group than in the non-elderly group. On multivariate logistic regression analysis, independent risk factors for poor prognosis included low fibrinogen and high D-dimer levels on admission. Posttraumatic coagulation and fibrinolytic abnormalities are more severe in older patients, and fibrinogen and D-dimer abnormalities are negative predictive factors.