Preoperative antithrombin supplementation in cardiac surgery: A randomized controlled trial

Abstract

Preoperative antithrombin supplementation prevents heparin resistance and avoids excessive postoperative decrease of antithrombin activity.

2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery

“…155 In a second RCT, AT supplementation also resulted in higher bleeding rates 12 h after surgery compared with the controls (mean blood loss 450 vs 350 ml, respectively; P ¼ 0.011). 167 In summary, AT supplementation is indicated in patients with AT deficiency to improve heparin sensitivity but should not be used prophylactically to reduce bleeding following CPB. FFP may be considered an alternative to AT supplementation in patients with AT deficiency to improve heparin sensitivity.…”

Effects of plasma transfusions on antithrombin levels after paediatric liver transplantation

“…In a retrospective study of 31 paediatric patients receiving ECMO support, the use of AT concentrates increased AT levels without any effect on heparin dose, activated clotting time, or measures of bleeding . A recent randomized controlled trial of AT supplementation versus placebo in 194 adults undergoing cardiopulmonary bypass did not show any significant difference in clinical outcome, except for increased blood loss in the group who received AT . A similar study has just been completed in children (<7 months) undergoing cardiac surgery (NCT02103114, no published results) .…”

A Pilot Study of Antithrombin Replacement Prior to Cardiopulmonary Bypass in Neonates

“…In vitro and in vivo studies of adult patients during CPB indicate that low antithrombin levels correlate with a decreased responsiveness to heparin and result in an activation/consumption of coagulation factors (10). Antithrombin supplementation to adults undergoing surgery requiring CPB has resulted in improved laboratory response to heparin (11)(12)(13)(14), decrease in hemostatic activation (13,15), and no significant adverse outcomes (12,14,16).…”

“…Antithrombin levels are decreased in normal neonates compared with older children and adults (6) and are even lower in infants with congenital heart disease (7)(8)(9). Antithrombin supplementation to adults undergoing surgery requiring CPB has resulted in improved laboratory response to heparin (11)(12)(13)(14), decrease in hemostatic activation (13,15), and no significant adverse outcomes (12,14,16). Antithrombin supplementation to adults undergoing surgery requiring CPB has resulted in improved laboratory response to heparin (11)(12)(13)(14), decrease in hemostatic activation (13,15), and no significant adverse outcomes (12,14,16).…”