[Antithrombin III concentrate use in patients with cirrhosis with coagulation disorders].
BACKGROUND
Patients with severe hepatic failure present acquired deficiency of antithrombin III (ATIII) owing to reduced synthesis associated with intravascular activation of blood coagulation, which may be corrected by ATIII infusion.


OBJECTIVE
The aim of this uncontrolled trial was to verify the effect of a standard dose of ATIII concentrate (Kybernin), that is, 50 U/kg of body weight per day, every 2 days, on ATIII levels in patients with severe hepatic failure and hemostatic imbalance.


METHODS
Six cirrhotic patients were studied: mean age of 44 years (14 to 63 years), who presented at least 2 abnormal coagulation tests (PT > 1.40, APTT > 1.25, Fibrinogen < 1.5 g/dL, Platelet count < 80,000/mm3). Mean serum albumin was 2.6 g/dL (1.9 to 3.8 g/dL). Blood was drawn before infusion, 4 h after the first infusion, and just before the next infusion. ATIII levels were measured by amidolytic method.


RESULTS
Mean ATIII levels were: initial = 35.8%, 4th h = 56.2%*, 2nd d = 48.7%*, 4th d = 45.7%*, and 8th d = 42.3%. ATIII levels increased significantly after infusion of this standard dose in all patients, although they have not been fully corrected (Friedman test, * p < 0.02), which has been sustained till the 4th day. There was no improvement on the clinical outcome.


CONCLUSIONS
These findings suggest that doses of ATIII concentrate higher than 50 U/kg/infusion must be administered to patients with severe hepatic failure, to guarantee normal levels of the inhibitor, in order to verify its influence on the hemostatic mechanism.
Ribeiro
A A
AA
Disciplina de Hematologia, Universidade Federal de São Paulo, Escola Paulista de Medicina.
Lourenço
D M
DM
Toledo
C F
CF
Noguti
M A
MA
Borges
D R
DR
D000293:Adolescent; D000328:Adult; D000990:Antithrombin III / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006525:Hepatitis, Viral, Human / Q000150:complications; D006527:Hepatolenticular Degeneration / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008108:Liver Diseases, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011517:Prothrombin Time; D015842:Serine Proteinase Inhibitors / Q000627:therapeutic use*
D015842:Serine Proteinase Inhibitors; D000990:Antithrombin III
Uso de concentrado de antitrombina III em cirróticos com distúrbios de coagulação.