SOLUBLE FIBRIN AND D-DIMER AS DETECTORS OF HYPERCOAGULABILITY IN PATIENTS WITH ISOLATED BRAIN TRAUMA

To test the hypothesis that hypercoagulability after brain trauma was related to the severity of injury and also to outcome, new coagulation markers were used in 20 patients with isolated brain trauma. In addit ion to routine coagulation tests, soluble fibrin (SF), D-dimer, and an tithrombin (AT) levels were assessed. Thirteen of 20 patients had a Gl asgow coma score (GCS) of less-than-or-equal-to 7 on admission and sev ere disability (SD) or worse on the Glasgow outcome scale (GOS). Eight patients had a very bad outcome [GOS = dead (D) or vegetative (V)]. A ll patients had increased SF levels (ref. <15 nmol/L) at admission. Si x patients with SF < 50 nmol/L had a good outcome with moderate disabi lity (MD) or better. Patients with increasingly higher SF levels had a worse outcome: Three of five patients with SF 50 to 150 nmol/L were s everely disabled (SD) or worse; four of six patients with SF > 150 nmo l/L remained vegetative (V) or died (D). Four of the six patients with the highest D-dimer levels at admission remained vegetative (V) or di ed (D). Six of 13 patients with a significant drop in AT levels had a bad outcome (D or V) whereas only two of seven patients without AT con sumption did poorly. Routine coagulation studies were often pathologic , i.e., reduced platelet count, but there was no relation to outcome. Increased SF and D-dimer levels at admission followed by a secondary d ecrease in AT concentration and platelets seem to be good markers of t he posttraumatic hypercoagulation often seen after brain injury. There was a significant relation between SF levels, severity of brain injur y (GCS), and subsequent outcomes (GOS) in severely head-injured patien ts.