Effect of long-term and high-dose antithrombin supplementation on coagulation and fibrinolysis in patients with severe sepsis*

Hoffmann, Johannes N.; Mühlbayer, Dieter; Jochum, Marianne; Inthorn, D.

doi:10.1097/01.ccm.0000139691.54108.1f

Cited by 54 publications

(40 citation statements)

References 40 publications

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“…In these studies, significant improvement of coagulation and fibrinolytic markers following antithrombin administration was noticed; however, antithrombin had no effect on the course of platelet counts over time [4,12,19]. In the present study, we observed a significant increase in the platelet counts and fibrinogen levels in responders.…”

Section: Discussionsupporting

confidence: 70%

“…Several studies reported an effect of antithrombin administration on hemostatic variables in critically ill patients [4,12,29]. In these studies, significant improvement of coagulation and fibrinolytic markers following antithrombin administration was noticed; however, antithrombin had no effect on the course of platelet counts over time [4,12,19].…”

Section: Discussionmentioning

confidence: 99%

“…Hoffmann et al [12] demonstrated that long-term and high-dose antithrombin supplementation significantly reduced septic coagulopathy response in postsurgical patients with severe sepsis. Low antithrombin levels after cardiac operations were associated with a poor outcome and antithrombin levels are predictive of a prolonged intensive care unit (ICU) stay [13].…”

Section: Introductionmentioning

confidence: 99%

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First day dynamic changes in antithrombin III activity after supplementation have a predictive value in critically ill patients

et al. 2006

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To evaluate the changes in the antithrombin III (antithrombin) values after initial supplementation to predict outcome in critically ill patients, we conducted a retrospective study. All consecutive patients admitted to the intensive care unit (ICU) and treated with antithrombin were enrolled in the study. Initial doses of 1,500 IU or 30 IU/kg antithrombin concentrates were administered over an hour. The clinical backgrounds of the patients were collected from computer-based records. Serial data of antithrombin were collected from the first day of administration (Day 0) to days 1-4. The patients were subdivided into two groups based on whether they demonstrated an increased antithrombin activity of more than 60% on the first day after the initial supplementation (responders) or not (nonresponders). Four hundred thirty-five patients were enrolled in the present study. Two hundred eighty-eight patients could achieve an antithrombin activity of more than 60%. The outcome was significantly different between the two groups. A logistic regression analysis revealed the day 1 antithrombin level and an initial increase of less than 60% after supplementation to be independently associated with ICU mortality. We also found a significant increase in the platelet counts and fibrinogen levels, and a decrease in the disseminated intravascular coagulation (DIC) scores for the responders. In conclusion, our findings demonstrated the first-day dynamic change in antithrombin activity, and not the basal level, to be able to predict critically ill patient death. This dynamic change was associated with an improvement in the platelet counts, fibrinogen levels, and the DIC score. Am. J. Hematol. 81:907-914, 2006.Wiley-Liss, Inc.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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First day dynamic changes in antithrombin III activity after supplementation have a predictive value in critically ill patients

et al. 2006

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“…Four-day antithrombin therapy did not attenuate hypercoagulability measured according to the platelet counts and global markers of coagulation and thromboelastography in patients with sepsis [28]. Hoffmann et al [29] indicated that long-term and high-dose antithrombin supplementation reduces septic coagulatory responses in patients with severe sepsis when given over 14 days. In their study, the antithrombin effects on platelet counts and markers of coagulation and fibrinolysis became evident after one week of therapy.…”

Section: Discussionmentioning

confidence: 99%

A Randomized, Controlled, Multicenter Trial of the Effects of Antithrombin on Disseminated Intravascular Coagulation in Patients With Sepsis

Gando

Saitoh²,

Ishikura³

et al. 2013

Chest

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“…Unter dieser individualisierten Substitution normalisierten sich die globalen Gerinnungstests; es erhöhten sich die Faktor-II-Aktivität, die Konzentrationen von Fibrinogen, Präkallikrein und Protein C. Antithrombin hatte keinen Einfluss auf C1-Esterase-Inhibitor (C1-INH), Plasminogen, α 2 -Antiplasmin und Plättchenzahl. Die Kontrollgruppe zeigte hingegen keine Veränderung der Parameter [13]. …”

Section: Weitere Datenunclassified

Schwere Sepsis und disseminierte intravasale Gerinnung

Angstwurm

Hoffmann²,

Ostermann

et al. 2009

Anaesthesist

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Administration of high-dose antithrombin (AT) was investigated on a large collective of patients with severe sepsis in the KyberSept study. In the total study the administration of AT resulted in no significant reduction of the mortality rate in comparison to a placebo. However, in the protocol of this study subgroups were predefined, which when analyzed revealed that the group of patients who received AT but not simultaneously heparin did show a reduction of the mortality rate in comparison to the placebo group. The reduction of the absolute mortality rate of 15% reached statistical significance on day 90. Even patients classified as risk group grade II according to the Simplified Acute Physiology Score (SAPS), showed a significant reduction of the mortality rate of approximately 22% after 90 days without simultaneous administration of heparin. Such a positive result for administration of AT without simultaneous heparin treatment can also be found when severe sepsis complicated by disseminated intravascular coagulation (DIC) is present. Coagulation diagnostic assists the recognition of latent or fulminant DIC and also in surveillance of the course and development. The results of AT supplementation for severe sepsis and DIC are in agreement with earlier studies on smaller patient collectives and suggest that a randomized controlled clinical study should be carried out on a subcollective of severely ill patients.

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Effect of long-term and high-dose antithrombin supplementation on coagulation and fibrinolysis in patients with severe sepsis*

Abstract: In this first study on long-term antithrombin therapy, antithrombin significantly reduced septic coagulatory response in patients with severe sepsis when given over 14 days.

Cited by 54 publications

References 40 publications

First day dynamic changes in antithrombin III activity after supplementation have a predictive value in critically ill patients

First day dynamic changes in antithrombin III activity after supplementation have a predictive value in critically ill patients

A Randomized, Controlled, Multicenter Trial of the Effects of Antithrombin on Disseminated Intravascular Coagulation in Patients With Sepsis

Schwere Sepsis und disseminierte intravasale Gerinnung

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