The Trajectories of Platelet, Fibrinogen, and D-dimer in Severe Trauma Patients and Their Value in Predicting Venous Thromboembolism: A Retrospective Study.

BACKGROUND

Venous thromboembolism (VTE) is a major contributor to morbidity and mortality in severe trauma (ST) patients. Platelet count (PLT), fibrinogen level (FIB), and D-dimer level are important coagulation indicators; however, few studies have described their trajectory in ST and assessed predictive value for VTE in clinical and nursing practice.

OBJECTIVE

To describe the trajectories of PLT, FIB, and D-dimer on days 1, 3, 5, and 7 after ST, and to evaluate their predictive value for post-traumatic VTE.

METHODS

Clinical data, including PLT, FIB, and D-dimer, were retrospectively collected from 184 ST patients. Univariate analysis and multivariate logistic regression analysis were used to identify independent risk factors for intramuscular venous thrombosis (IMVT), deep vein thrombosis (DVT), and pulmonary embolism (PE) in ST patients. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive performance of these independent risk factors.

RESULTS

PLT showed a decreasing trend from day 1 to day 3 after trauma, followed by an increasing trend from day 3 to day 7. FIB dropped sharply to the lowest value on day 1 after trauma and then gradually increased. D-dimer surged sharply to the peak on day 1 after trauma, decreased gradually in the first 3 days, and then increased slowly from day 3 to day 7. Multivariate logistic regression analysis identified D-dimer level on day 5 as an independent risk factor for both IMVT (OR=1.133, 95% CI: 1.032-1.243; P=0.009; AUC=0.561) and PE (OR=1.085, 95% CI: 1.016-1.160; P=0.015; AUC=0.721). PLT and FIB were not identified as independent risk factors for IMVT, DVT, or PE.

CONCLUSIONS

This study demonstrated that while the dynamic changes in PLT, FIB, and D-dimer can reflect the transition of coagulation status after ST, their value as independent VTE predictive tools is limited. In clinical and nursing practice, it is crucial to determine the timing of coagulation status transition after trauma and explore the optimal timing for pharmacological prophylaxis.