Association of Fibrinolysis Phenotype with Patient Outcomes following Traumatic Brain Injury.
Journal
The journal of trauma and acute care surgery
ISSN: 2163-0763
Titre abrégé: J Trauma Acute Care Surg
Pays: United States
ID NLM: 101570622
Informations de publication
Date de publication:
13 Sep 2023
13 Sep 2023
Historique:
medline:
13
9
2023
pubmed:
13
9
2023
entrez:
13
9
2023
Statut:
aheadofprint
Résumé
Impaired coagulation is associated with elevated risk of mortality in trauma patients. Prior studies have demonstrated increased mortality in patients with hyperfibrinolysis (HF) and fibrinolysis shutdown (SD). Additionally, prior studies have demonstrated no effect of tranexamic acid (TXA) on fibrinolysis phenotypes. We examined the association of admission fibrinolysis phenotype with traumatic brain injury (TBI) patient outcomes. Data were extracted from a placebo-controlled multicenter clinical trial. Patients ≥15 years old with TBI (Glasgow Coma Scale 3-12) and systolic blood pressure ≥ 90 mmHg were randomized in the out-of-hospital setting to receive placebo bolus/placebo infusion (Placebo), 1 gram (g) TXA bolus/1 g TXA infusion (Bolus Maintenance [BM]); or 2 g TXA bolus/placebo infusion (Bolus Only [BO]). Fibrinolysis phenotypes on admission were determined by clot lysis at 30 minutes (LY30): SD ≤0.8%, physiologic 0.9-2.9%, HF ≥3%. Logistic regression was used to control for age, sex, penetrating injury, ISS, maximum head AIS, and TXA treatment group. 747 patients met inclusion criteria. Fibrinolysis shutdown was the most common phenotype in all treatment groups and was associated with increased age, ISS and presence of intracranial hemorrhage (ICH). Inpatient mortality was 15.2% for SD and HF, and 10.6% for physiologic (p = 0.49). No differences in mortality, disability rating scale at 6 months, acute kidney injury, acute respiratory distress syndrome, or multi-organ failure were noted between fibrinolysis phenotypes. SD is the most common phenotype expressed in moderate to severe TBI. In TBI, there is no association between fibrinolysis phenotype and mortality or other major complications. diagnostic test/criteria, III.
Sections du résumé
BACKGROUND
BACKGROUND
Impaired coagulation is associated with elevated risk of mortality in trauma patients. Prior studies have demonstrated increased mortality in patients with hyperfibrinolysis (HF) and fibrinolysis shutdown (SD). Additionally, prior studies have demonstrated no effect of tranexamic acid (TXA) on fibrinolysis phenotypes. We examined the association of admission fibrinolysis phenotype with traumatic brain injury (TBI) patient outcomes.
METHODS
METHODS
Data were extracted from a placebo-controlled multicenter clinical trial. Patients ≥15 years old with TBI (Glasgow Coma Scale 3-12) and systolic blood pressure ≥ 90 mmHg were randomized in the out-of-hospital setting to receive placebo bolus/placebo infusion (Placebo), 1 gram (g) TXA bolus/1 g TXA infusion (Bolus Maintenance [BM]); or 2 g TXA bolus/placebo infusion (Bolus Only [BO]). Fibrinolysis phenotypes on admission were determined by clot lysis at 30 minutes (LY30): SD ≤0.8%, physiologic 0.9-2.9%, HF ≥3%. Logistic regression was used to control for age, sex, penetrating injury, ISS, maximum head AIS, and TXA treatment group.
RESULTS
RESULTS
747 patients met inclusion criteria. Fibrinolysis shutdown was the most common phenotype in all treatment groups and was associated with increased age, ISS and presence of intracranial hemorrhage (ICH). Inpatient mortality was 15.2% for SD and HF, and 10.6% for physiologic (p = 0.49). No differences in mortality, disability rating scale at 6 months, acute kidney injury, acute respiratory distress syndrome, or multi-organ failure were noted between fibrinolysis phenotypes.
CONCLUSION
CONCLUSIONS
SD is the most common phenotype expressed in moderate to severe TBI. In TBI, there is no association between fibrinolysis phenotype and mortality or other major complications.
LEVEL OF EVIDENCE
METHODS
diagnostic test/criteria, III.
Identifiants
pubmed: 37700441
doi: 10.1097/TA.0000000000004122
pii: 01586154-990000000-00498
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of Interest: All JTACS Disclosure forms have been supplied and are provided as supplemental digital content (http://links.lww.com/TA/D253).