Defibrination after Brain-Tissue Destruction

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Abstract
A prospective study was conducted to evaluate defibrination after acute head trauma. Defibrination was not observed in 13 patients In whom trauma apparently did not destroy brain tissue. In contrast, evidence of defibrination — hypofibrinogenemia, elevated levels of serum fibrinogen-related or fibrin-related antigen and low levels of factors V, VIII or platelets — was found in nine of 13 patients in whom brain-tissue destruction was established by direct inspection. All nine patients had a strongly positive protamine test, suggesting that intravascular coagulation had occurred. Since test results returned toward normal within hours, the active phase of defibrination apparently was brief. Nevertheless, hemostatic abnormalities were severe enough to have affected the neurologic consequences of intracranial bleeding. Clinical findings attributable to fibrin in the microcirculation (e.g., microangiopathic hemolytic anemia or renal failure) were not encountered. The potentially salvageable patient with acute traumatic brain-tissue destruction may require emergency replacement of hemostatic factors. (N Engl J Med 290:1043–1047, 1974)