The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease

Abstract

Despite thrombin inhibition by AT III in patients with end-stage chronic liver disease, systemic procoagulant turnover was not significantly decreased 60 min after AT III application even to supranormal activities. Replenishment of the inhibitory antithrombin III pool, decreased in chronic liver disease, should not be expected to slow down the baseline consumptive component of the haemostatic disorder in this patient group.

Impact of Antithrombin III Concentrates on Portal Vein Thrombosis After Splenectomy in Patients With Liver Cirrhosis and Hypersplenism

“…36 Since AT-III concentrates can improve the increased fibrinogen turnover in patients with cirrhosis, 39 several clinical studies with AT-III concentrates have been performed in attempts to prevent perioperative DIC and bleeding complication in cirrhotic patients with fulminant hepatic failure, 40 the LeVeen shunt operation, 41 hepatic resection, 42 or liver transplantation. 43 Although these studies did not show significant beneficial effects of the perioperative usage of AT-III concentrates in cirrhotic patients, the present study is the first to demonstrate the feasibility of AT-III concentrates in cirrhotic patients who are undergoing surgery. The previous and present studies do not show any adverse effects, such as bleeding complications and hepatic damages, indicating that the perioperative use of AT-III concentrates is safe, even in cirrhotic patients.…”

Haemostatic disorders during liver transplantation

“…Replenishment of antithrombin III has not modi®ed the baseline consumptive component of the haemostatic disorders observed in such patients in a recent randomized study [35]. Attempts to correct them by substitution of clotting factors are still under debate.…”

“…In patients with end‐stage chronic liver disease, no special preoperative coagulation management is necessary in the absence of bleeding. Replenishment of antithrombin III has not modified the baseline consumptive component of the haemostatic disorders observed in such patients in a recent randomized study [35].…”

AICF and DIC in Liver Cirrhosis: Expressions of a Hypercoagulable State

“…Will use of special tests for AICF employed in this study (such as F1.2, TAT, ATIII, and D-dimer), which are currently not available in most clinical laboratories or not routinely used, be helpful in the management of patients with liver cirrhosis? The finding that the extent of AICF may be inversely related to the level of ATIII (18,20) and that shortened fibrinogen survival could be prolonged (11) and fibrinogen increased (27) with administration of ATIII might indicate a possible beneficial effect of ATIII in patients with very low levels of ATIII and, thus, usefulness of monitoring of ATIII. Whether selected patients with evidence of AICF may benefit from heparin therapy, perhaps in low doses and combined with ATIII, as has been suggested by observational studies (28,29), remains to be determined by controlled studies.…”