Research progress in application of low molecular weight heparin assisted by anti-X activity monitoring in the prevention of thrombosis after traumatic brain injury / 中华创伤杂志

The incidence of venous thromboembolism（VTE）in patients with traumatic brain injury（TBI）, especially in patients with severe TBI, is significantly increased due to disturbance of consciousness and limb movement. In the acute phase of VTE, low molecular weight heparin（LMWH）is the most commonly used safe and effective measure to prevent thrombosis. Due to the changes of injury condition of trauma patients, the deviation of clinicians' understanding of VTE and the medication habits of various medical institutions, there are significant differences in the initial time and dose of LMWH prevention. Insufficient or excessive dose of LMWH will lead to thrombus or bleeding complications. In recent years, administration of LMWH with anti-X activity monitoring has been paid more and more attention in patients with TBI, playing an important role in reducing the incidence of thrombosis. The authors review the research progress in the application of LMWH with anti-X activity monitoring in thrombus prevention in patients with TBI from the aspects of mechanism in LMWH use with anti-X activity monitoring, LWMH medication time window and anti-X activity monitoring, LWMH dose adjustment and anti-X activity monitoring, in order to provide references for clinical treatment.

Dynamic changes of sex hormones and T-cell phenotype after traumatic brain injury / 中华创伤杂志

Objective To investigate the roles of sex hormones and T-cell phenotype in traumatic brain injury (TBI). Methods Within 12 hours, 1, 3 and 7 days after TBI, a dynamic observation and a correlative analysis were performed on CD4 + and CD8 + lymphocytes in the serum and on the changes of estradiol, progesterone and testosterone in the cerebrospinal fluid (CSF) and serum in all cases. Results The CD4 + and CD8 + lymphocytes were inhibited and decreased with injury severity. The estradiol and progesterone levels in serum and cerebrospinal fluid (CSF) increased within 12 hours after trauma in all groups. Estradiol increased markedly continuously within 1, 3 and 7 days and progesterone sustained high within seven days in GCS≤8 group, with a significant difference compared with others groups. The testosterone levels in serum and CSF decreased in the death group. There was a positive correlation between the changes of CD4 + lymphocytes and the levels of serum estradiol, progesterone and testosterone in the death group. Conclusions The increases of estradiol (in the early stage) and progesterone (in the late stage) after TBI may exert powerful protective effects on brain tissues. Decreases of sex hormones and T lymphocyte are important factors leading to death of patients.