{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T12:26:06Z","timestamp":1789820766652,"version":"4.0.1"},"reference-count":40,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>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.<\/jats:p><\/jats:sec>Objective<\/jats:title>To assess whether changes in antithrombin III activity are associated with thrombohemorrhagic complications among patients with trauma.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>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.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>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)\u2013free days, hemorrhage, venous thromboembolic events, and mortality.<\/jats:p><\/jats:sec>Results<\/jats:title>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<\/jats:italic>\u2009=\u2009.0003), hospital-free days (20.3 [8.2] vs 24.0 [5.7]; P<\/jats:italic>\u2009=\u20091.37\u2009\u00d7\u200910\u22126<\/jats:sup>), and ICU-free days (25.7 [4.9] vs 27.7 [2.3]; P<\/jats:italic>\u2009=\u20099.38\u2009\u00d7\u200910\u22126<\/jats:sup>) 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<\/jats:italic>\u2009=\u2009.0003) and thrombocytopenia (24.8% [33 of 133] vs 5.0% [8 of 159]; P<\/jats:italic>\u2009=\u20091.94\u2009\u00d7\u200910\u22126<\/jats:sup>). 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.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>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.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.27786","type":"journal-article","created":{"date-parts":[[2024,8,15]],"date-time":"2024-08-15T15:01:13Z","timestamp":1723734073000},"page":"e2427786","source":"Crossref","is-referenced-by-count":13,"title":["Antithrombin III Levels and Outcomes Among Patients With Trauma"],"prefix":"10.1001","volume":"7","author":[{"given":"David H.","family":"Farrell","sequence":"first","affiliation":[{"name":"Donald D. Trunkey Center for Civilian and Combat Casualty Care, Oregon Health & Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keeley M.","family":"McConnell","sequence":"additional","affiliation":[{"name":"Donald D. 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