@article{ref1,
title="Incidence of antithrombin deficiency and anti-cardiolipin antibodies after severe traumatic brain injury: a prospective cohort study",
journal="Neurocritical care",
year="2020",
author="Kalgudi, Shankar and Ho, Kwok M.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="BACKGROUND: Animal studies suggested that cerebral mitochondrial cardiolipin phospholipids were released after severe traumatic brain injury (TBI), contributing to the pathogenesis of thromboembolism. <br><br>OBJECTIVES: To determine the incidence of anti-cardiolipin antibodies after severe TBI and whether this was related to the severity of TBI and development of venous thromboembolism. <br><br>METHODS: Serial anti-cardiolipin antibodies, antithrombin levels, viscoelastic testing, and coagulation parameters were measured on admission, day-1, and between day-5 and day-7 in patients with severe TBI requiring intracranial pressure monitoring. <br><br>RESULTS: Of the 40 patients included (85% male and median age 42 years), 7 (18%) had a raised Ig-G or Ig-M anti-cardiolipin antibody titer after TBI. Antithrombin levels were below the normal level-especially on day-0 and day-1-in 15 patients (38%), and 14 patients (38%) developed an increase in maximum clot firmness on the viscoelastic test in conjunction with elevations in fibrinogen concentration and platelet count. Four patients (10%) developed deep vein thrombosis, and 10 patients (25%) died, both of which were not significantly related to the presence of anti-cardiolipin antibodies (P = 0.619 and P = 0.638, respectively). <br><br>CONCLUSIONS: A reduction in antithrombin level and development of anti-cardiolipin antibodies were not rare immediately after severe TBI; these abnormalities were followed by an increase in in vitro clot strength due to elevations in fibrinogen concentration and platelet count. The quantitative relationships between the development of anti-cardiolipin antibodies and severity of TBI or clinical thromboembolic events deserve further investigation.<p /> <p>Language: en</p>",
language="en",
issn="1541-6933",
doi="10.1007/s12028-020-01026-x",
url="http://dx.doi.org/10.1007/s12028-020-01026-x"
}