Fibrinolysis in Traumatic Brain Injury: Diagnosis, Management, and Clinical Considerations

Area of Science:

• Trauma and Emergency Medicine
• Hematology
• Neurocritical Care

Background:

• Posttraumatic coagulopathy disrupts coagulation and fibrinolysis after injury.
• Hyperfibrinolysis in traumatic brain injury (TBI) is linked to uncontrolled bleeding and increased mortality.
• Current diagnostic methods for fibrinolysis in TBI have limitations.

Purpose of the Study:

• To review the clinical aspects of fibrinolysis in TBI.
• To discuss diagnosis, treatment, and clinical correlates of fibrinolysis in TBI.
• To identify future research directions for TBI-related fibrinolysis.

Main Methods:

• Literature review of studies on fibrinolysis in TBI.
• Analysis of diagnostic biomarkers and viscoelastic tests.
• Evaluation of treatment strategies for fibrinolytic disruption.

Main Results:

• Hyperfibrinolytic state in TBI is associated with poor outcomes.
• D-dimer and fibrin degradation products show potential but are delayed.
• Viscoelastic tests offer rapid assessment but fibrinolytic capacity is unclear.
• Limited evidence supports current treatments; tranexamic acid shows recent promise.

Conclusions:

• Fibrinolysis plays a critical role in TBI pathophysiology and outcomes.
• Further research is needed to understand TBI phenotypes and fibrinolysis.
• Early intervention with tranexamic acid may improve outcomes in specific TBI cases.