Temporal changes of the von Willebrand factor-ADAMTS13 axis during the first 24 hours in major trauma patients with isolated brain injury and without brain injury: a prospective observational study

Background: Dysregulation of the VWF–ADAMTS13 (von Willebrand factor–a disintegrin and metalloprotease with thrombospondin type 1 motif, member 13) axis contributes to trauma-induced coagulopathy (TIC) and adverse outcomes after trauma. Whether this dysregulation is injury-specific remains unclear. We investigated early and temporal changes in the VWF–ADAMTS13 axis in isolated trauma brain injury (iTBI) patients versus non-TBI trauma patients. Material and methods: In a prospective observational cohort study, 50 iTBI patients and 50 non-TBI trauma patients were recruited at Antwerp University Hospital (June 2023–January 2025). VWF antigen (VWF:Ag), VWF collagen binding activity (VWF:CBA), VWF platelet GPIb binding activity (VWF:GPIb), VWF multimers, ADAMTS13 antigen (ADAMTS13:Ag), ADAMTS13 activity (ADAMTS13:Ac), factor VIII coagulant activity (FVIII:C), and activated protein C (aPC) were measured at admission (T ED ) and at 24 hours (T 24 ). Linear mixed-effects models assessed time- and group-dependent changes. Results: In non-TBI patients, VWF:Ag, VWF:CBA, and VWF:GPIb decreased from T ED to T 24 by 51.33 IU/dL (95% CI: −70.12, −32.54; p < 0.001), 51.08 IU/dL (95% CI: −77.38, −24.77; p < 0.001), and 65.52 IU/dL (95% CI: −94.50, −36.55; p < 0.001), respectively. No such changes were observed in iTBI patients. The ADAMTS13:Ac/VWF:Ag ratio was 34% higher at T ED in iTBI patients compared to non-TBI patients (1.34 [95% CI: 1.07–1.68]; p = 0.01) and decreased by 23% from T ED to T 24 exclusively in iTBI patients (0.77 [95% CI: 0.67–0.88]; p < 0.001). Temporal changes were similar between groups for the remaining parameters: ADAMTS13:Ag decreased by 11.44 IU/dL (95% CI: −15.93, −6.95; p < 0.001), ADAMTS13:Ac by 14.26 IU/dL (95% CI: −18.06, −10.45; p < 0.001), and FVIII:C by 73.06 IU/dL (95% CI: −94.50, −51.62; p < 0.001). The aPC ratio increased by 0.07 (95% CI: 0.05, 0.10; p < 0.001). Conclusion: Temporal changes of the VWF–ADAMTS13 axis differ between iTBI and non-TBI trauma patients within the first 24 hours after injury, suggesting injury-specific regulation of coagulation and endothelial responses that may support personalized coagulation strategies.