重症頭部外傷急性期における凝固線溶系の年齢階級別評価と治療戦略

抄録

Objectives: We aimed to evaluate coagulation-fibrino­lysis abnormalities in patients with severe head trauma according to the age group and focal injury vs diffuse brain injury type.

Methods: We included 56 patients and divided them into three age groups: the young group comprised 9 patients aged ≤19 years; the middle-aged group, 24 patients aged 20 – 64 years; and the elderly group, 23 patients aged ≥65 years. These three groups were com­pared in terms of the following: level of consciousness on admissioin; imaging findings; hemoglobin (Hb), platelets (Plt), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, fibrin ⁄ fi­brino­gen degradation products (FDPs) and D-dimer; and mortality rates.

Results: The consciousness level on admission did not differ between the groups. Comparison of imaging findings revealed that the young group had a high proportion of patients with traumatic subarachnoid hemorrhage, while the middle-aged and elderly group had a high proportion of patients with brain contusion and acute subdural hematoma. No significant differ­ences were noted between the groups in Hb, Plt, PT, APTT, or fibrinogen levels. However, FDP and D-dimer levels were significantly higher in the middle-aged and elderly group. The middle-aged and elderly group also showed a significantly higher mortality rate than the young group.

Conclusions: The proportion of patients with focal brain injury was higher in the middle-aged and elderly group than in the young group, and patients in the middle-aged and elderly group developed hyper­fibrinolysis immediately after sustaining injuries. There is no reliable treatment for hyperfibrinolysis. Investigating the effect of treatment of hyper­fibrinolysis in severe head trauma should be a priority for future research.