Background: Antithrombin is a major anticoagulant controlling inflammation as well as coagulation. Low antithrombin level has been considered one of causes of organ dysfunction and poor outcome in disseminated intravascular coagulation (DIC).

Aims: We retrospectively analyzed serial changes in the levels of antithrombin to clarify its roles in trauma patients associated with DIC.

Methods: The 259 trauma patients were included and subdivided into 153 DIC and 106 non-DIC patients. Serial changes in platelet counts and coagulofibrinolytic parameters as well as antithrombin levels were evaluated from immediately after arrival at the emergency department (day 0), day 1 and days 2 to 6 (Late stage). During late stage, lowest antithrombin levels were used for analysis. Organ dysfunction was evaluated by Sequential Organ Failure Assessment (SOFA) socre and SOFA>12 was defined as multiple organ dysfunction syndome (MODS). Outcome measure was all-cause hospital mortality.

Results: DIC patients showed peresistently lower antithrombin levels at day 0 (63.8%), day 1(60.4%), and Late stage (60.9%) thant non-DIC patients (79.0, 77.0, 74.5%) (p<0.001) and was associated significantly higher rates of MODS (24.8 vs. 18,9%) and hospital mortarity (28.1 vs. 7.5%) than non-DIC patients. In addition, antithrombin levels at day 0 in died DIC patients (56.8%) were lower than that of survivors (66.5%) (p<0.001). Antithrombin levels at day 0 were independent predictor of death (Odds, 0.97; 95% CI 0.95-0.98, p<0.001). 

Conclusions: DIC, especially died DIC patients, showed persistently low antithrombin levels immediate to late stage of trauma. Low antithrombin levels may have role in poor prognosis of trauma patients.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/persistently-low-levels-of-antithrombin-in-trauma-patients-associated-with-disseminated-intravascular-coagulation/