Donald D. Trunkey Center for Civilian and Combat Casualty Care, Oregon Health & Science University, Portland.
Division of Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis.
JAMA Netw Open. 2024 Aug 1;7(8):e2427786. doi: 10.1001/jamanetworkopen.2024.27786.
Patients with trauma exhibit a complex balance of coagulopathy manifested by both bleeding and thrombosis. Antithrombin III is a plasma protein that functions as an important regulator of coagulation. Previous studies have found a high incidence of antithrombin III deficiency among patients with trauma.
To assess whether changes in antithrombin III activity are associated with thrombohemorrhagic complications among patients with trauma.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted from December 2, 2015, to March 24, 2017, at a level I trauma center. A total of 292 patients with trauma were followed up from their arrival through 6 days from admission. Data, including quantification of antithrombin III activity, were collected for these patients. Thromboprophylaxis strategy; hemorrhage, deep vein thrombosis (DVT), and pulmonary embolism screenings; and follow-up evaluations were conducted per institutional protocols. Data analyses were performed from September 28, 2023, to June 4, 2024.
The primary study outcome measurements were associations between antithrombin III levels and outcomes among patients with trauma, including ventilator-free days, hospital-free days, intensive care unit (ICU)-free days, hemorrhage, venous thromboembolic events, and mortality.
The 292 patients had a mean (SD) age of 54.4 (19.0) years and included 211 men (72.2%). Patients with an antithrombin III deficiency had fewer mean (SD) ventilator-free days (27.8 [5.1] vs 29.6 [1.4]; P = .0003), hospital-free days (20.3 [8.2] vs 24.0 [5.7]; P = 1.37 × 10-6), and ICU-free days (25.7 [4.9] vs 27.7 [2.3]; P = 9.38 × 10-6) compared with patients without a deficiency. Antithrombin III deficiency was also associated with greater rates of progressive intracranial hemorrhage (21.1% [28 of 133] vs 6.3% [10 of 159]; P = .0003) and thrombocytopenia (24.8% [33 of 133] vs 5.0% [8 of 159]; P = 1.94 × 10-6). Although antithrombin III deficiency was not significantly associated with DVT, patients who developed a DVT had a more precipitous decrease in antithrombin III levels that were significantly lower than patients who did not develop a DVT.
In this cohort study of patients with trauma, antithrombin III deficiency was associated with greater injury severity, increased hemorrhage, and increased mortality, as well as fewer ventilator-free, hospital-free, and ICU-free days. Although this was an associative study, these data suggest that antithrombin III levels may be useful in the risk assessment of patients with trauma.
创伤患者表现出复杂的凝血功能障碍，既有出血又有血栓形成。抗凝血酶 III 是一种血浆蛋白，作为凝血的重要调节剂发挥作用。先前的研究发现，创伤患者中抗凝血酶 III 缺乏的发生率很高。
评估抗凝血酶 III 活性的变化是否与创伤患者的血栓栓塞并发症有关。
设计、设置和参与者：这项队列研究于 2015 年 12 月 2 日至 2017 年 3 月 24 日在一家一级创伤中心进行。共有 292 名创伤患者从入院到入院后 6 天进行了随访。为这些患者收集了包括抗凝血酶 III 活性定量在内的数据。根据机构方案进行了血栓预防策略、出血、深静脉血栓形成（DVT）和肺栓塞筛查以及随访评估。数据分析于 2023 年 9 月 28 日至 2024 年 6 月 4 日进行。
主要研究结果是抗凝血酶 III 水平与创伤患者结局之间的关联，包括无呼吸机天数、无住院天数、无 ICU 天数、出血、静脉血栓栓塞事件和死亡率。
292 名患者的平均（标准差）年龄为 54.4（19.0）岁，包括 211 名男性（72.2%）。抗凝血酶 III 缺乏症患者的平均（标准差）无呼吸机天数（27.8[5.1]与 29.6[1.4]；P=0.0003）、无住院天数（20.3[8.2]与 24.0[5.7]；P=1.37×10-6）和无 ICU 天数（25.7[4.9]与 27.7[2.3]；P=9.38×10-6）均少于无缺乏症的患者。抗凝血酶 III 缺乏症也与更高的进展性颅内出血发生率（21.1%[28/133]与 6.3%[10/159]；P=0.0003）和血小板减少症（24.8%[33/133]与 5.0%[8/159]；P=1.94×10-6）相关。尽管抗凝血酶 III 缺乏症与 DVT 无显著相关性，但发生 DVT 的患者抗凝血酶 III 水平急剧下降，明显低于未发生 DVT 的患者。
在这项创伤患者的队列研究中，抗凝血酶 III 缺乏与更严重的损伤、更多的出血和更高的死亡率以及更少的无呼吸机、无住院和无 ICU 天数有关。尽管这是一项相关性研究，但这些数据表明，抗凝血酶 III 水平可能有助于创伤患者的风险评估。
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