Incidence of Antithrombin Deficiency and Anti-Cardiolipin Antibodies After Severe Traumatic Brain Injury: A Prospective Cohort Study

Abstract

Background

Animal studies suggested that cerebral mitochondrial cardiolipin phospholipids were released after severe traumatic brain injury (TBI), contributing to the pathogenesis of thromboembolism.

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.

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.

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).

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.

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Acknowledgements

We would like to thank our study participants for their involvement in this study.

Funding

This study was solely funded internally by the Department of Intensive Care Medicine, Royal Perth Hospital, Perth, Western Australia. The funder plays no role in the study design, in the collection, analysis and interpretation of the data, in the writing of the report, and the decision to submit the article for publication.

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Authors

Contributions

SK was responsible for patient recruitment and data collection, data analysis and interpretation, and drafting the manuscript. KMH was responsible for study design, data analysis, and drafting the manuscript. Both authors agreed to the final version of the manuscript.

Corresponding author

Correspondence to Kwok M. Ho.

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The authors declare that they have no conflicts of interest in relation to the subject matter or any materials described in this manuscript.

Ethics Approval and STROBE Compliance Statement

This study has been approved by the Royal Perth Hospital Clinical Safety & Quality Unit (N-23831) and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This study is reported according to the STROBE requirements for observational studies.

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Kalgudi, S., Ho, K.M. Incidence of Antithrombin Deficiency and Anti-Cardiolipin Antibodies After Severe Traumatic Brain Injury: A Prospective Cohort Study. Neurocrit Care (2020). https://doi.org/10.1007/s12028-020-01026-x

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Keywords

  • Anti-cardiolipin antibodies
  • Antithrombin
  • Prothrombotic state
  • Traumatic brain injury
  • Venous thromboembolism