Implications of excessive fibrinolysis and α2-plasmin inhibitor deficiency in patients with severe head injury

Shigeki Kushimoto, Yasuhiro Yamamoto, Yasushi Shibata, Hidetaka Sato, Yuichi Koido

Research output: Contribution to journalArticlepeer-review

34 Citations (Scopus)

Abstract

OBJECTIVE: To evaluate the involvement of the fibrinolytic system, especially focused on α2-plasmin inhibitor, in patients with head injury. METHODS: This study consisted of 47 patients with isolated blunt head trauma in whom blood sampling could be initiated within 3 hours after injury. Patients were divided into two groups according to Glasgow Outcome Scale score status at 3 months after injury. In Group 1 patients (n = 26), the outcome was characterized as good recovery or moderate disability; in Group 2 patients (n = 21), the outcome was characterized as severe disability, vegetative state, or death. RESULTS: Concentrations of thrombin-antithrombin III complex were greater than 100 μg/L in 39 of 47 patients, and concentrations in Group 2 patients were elevated significantly beyond the concentrations in Group 1 patients. Activities of α2-plasmin inhibitor in Group 2 were significantly lower than in Group 1 (P < 0.0001). In Group 1 patients, α2-plasmin inhibitor activity was greater than 60%, while in all but four Group 2 patients, the inhibitor was reduced to less than 60% of normal activity within 3 hours of injury. All patients with α2-plasmin inhibitor activity less than 60% showed a marked bleeding tendency and/or severe brain edema. Using sandwich enzyme-linked immunosorbent assay, fibrinogen degradation product and fibrin degradation product were measured separately. A significant correlation was apparent between thrombin-antithrombin III complex and fibrinogen degradation product, as well as between the complex and fibrin degradation product. Marked decreases in α2-plasmin inhibitor were noted only in patients with thrombin-antithrombin III complex concentrations exceeding 500 μg/L. CONCLUSION: Fibrinolysis and fibrinogenolysis may be involved according to the degree of coagulation activation in the pathophysiology of severe head injury. Decreased activity of α2-plasmin inhibitor indicated poor prognosis and may be an exacerbating factor in the acute phase of head trauma.

Original languageEnglish
Pages (from-to)1084-1090
Number of pages7
JournalNeurosurgery
Volume49
Issue number5
DOIs
Publication statusPublished - 2001 Jan 1
Externally publishedYes

Keywords

  • Fibrinogenolysis
  • Fibrinolysis
  • Head injury
  • Intravascular coagulation
  • Plasmin
  • α-plasmin inhibitor

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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