Evaluation of Antitrombin-III in multiple traumatic patients with trauma scores in the Emergency Department

Introduction
Patients with multiple traumas are the patients that need to be evaluated quickly in the Emergency Services. Because they have different injuries that fall into the interest areas of different branches, the injury and the trauma needs to be scored and first aid principles should be applied. The scoring systems that are developed according to recent developments in medical science, help the quick and suitable triage of patients with multiple traumas to which transportation, first aid, resuscitation and treatment will be applied [4].

Many studies show that transportation of the injured patients to a health center that has limited opportunities, and the application of insufficient and time-wasting treatments to these patients, leads to higher than expected mortality rates [18]. Another important problem for patients with multiple trauma is the risk of thrombo-emboli which increases with the age and the severity of the patients' trauma. The importance of Anti-thrombin III (AT-III) on thrombo-emboli should also be emphasized [7]. 

AT-III is the main plasma protein responsible for the progressive inactivation of thrombin. The AT-III activity may decrease because of some pathological reasons. They are: 1) the absorption of thrombin on fibrin, 2) fibrinogen activity and the existence of fibrin destruction products, 3) the existence of cavalier heparin with the exception of the known plasma proteins known as heparin cofactor. One of the most important factors of the creation of thrombosis inside the vein is the hypercoagulability of the blood.  If there is a decrease in AT-III in the blood, this increases the risk of intravascular coagulation as blood is apt to coagulate and form thromboembolisms with a resultant increase in the incidence of atherosclerosis. Excess lipids in the blood cause hypercoagulability by inhibiting fibrinolytic activity [5,7,8,18].

It is observed that publications on studies of the risk of thrombo-emboli and AT-III and other hematological parameters on patients with multiple trauma is needed in our country. In this study, we aim to show how trauma severity and post-trauma time effect some blood parameters such as AT-III, blood thrombocyte count, active partial thromboplastine time (aPTT), prothrombin time (PT) and fibrinogen level.