Antithrombin treatment in patients with traumatic brain injury - A pilot study

This study will determine if early administration of antithrombin concentra te to patients with traumatic brain injury (TBI) can inhibit or significant ly shorten the time of coagulopathy. The progress of brain injury monitored by computed tomographic scan (CT) was also assessed, as was the time neede d for intensive care and outcome related to Glasgow outcome scale (GOS). Tw enty-eight patients with isolated brain trauma verified with CT were includ ed in either of two parallel groups. The Glasgow coma score (GCS) was mean 7.5, and median 7.0; signifying a moderate to severe traumatic brain injury but with a mortality of only 3.5 %. The patients randomized to antithrombi n treatment received a total of 100 U/kg BW during 24 hours. To measure hyp ercoagulability, soluble fibrin (SF), D-dimer (D-d), and thrombin-antithrom bin complex (TAT) were assessed together with antithrombin (AT) and routine coagulation tests. Before treatment, SF, D-d, and TAT were markedly increa sed in both groups. Soluble fibrin and D-dimer (measured after treatment be gan) appeared to decrease faster in the AT group, and there was a statistic ally significant difference between the groups at 36 hours for SF and at 36 hours, 48 hours, and at Day 3 for D-d. Thrombin-antithrombin complex level s were very high in both groups but, surprisingly, showed no significant di fference between the groups. The authors conclude that antithrombin concent rate administered to patients with severe TBI resulted in a marginal reduct ion of hypercoagulation. We could not detect any obvious influence by antit hrombin on brain injury progress, on CT, or on outcome or time needed for i ntensive care.