Therapeutic use of antithrombin concentrate in sepsis.
Sepsis and its associated complications of disseminated intravascular coagulation (DIC) and multiple organ dysfunction syndrome (MODS) continue to be a major cause of morbidity and mortality. Improved detection of all forms of DIC is essential to assure earlier diagnosis. Studies already indicate that the therapeutic use of antithrombin (AT) concentrate may produce a more positive outcome for sepsis-associated DIC. If DIC could be identified earlier and AT concentrate could then be given earlier in the sepsis continuum, study results for the use of AT concentrate in humans might reveal a statistically significant difference versus placebo, and the efficacy of AT concentrate for this syndrome is more likely to be proved. Fixed-bolus doses of AT concentrate based on body weight are currently preferred, but improved, user-friendly assays for plasma AT levels would permit more rapid turnaround time for AT results and could help fine-tune the use of AT concentrate to the specific needs of each patient. Clinical trials involving the therapeutic use of AT concentrate in sepsis should continue, and it can be hoped that their design will reflect the concepts and conclusions offered by this panel of investigators.
Balk
R
R
Department of Internal Medicine, Rush-Presbyterian St. Luke's Medical Center, Chicago, Illinois, USA.
Emerson
T
T
Fourrier
F
F
Kruse
J A
JA
Mammen
E F
EF
Schuster
H P
HP
Vinazzer
H
H
D000818:Animals; D000990:Antithrombin III / Q000008:administration & dosage / Q000032:analysis / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology / Q000517:prevention & control; D004311:Double-Blind Method; D004353:Drug Evaluation, Preclinical; D011464:Epoprostenol / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D015993:Life Tables; D009102:Multiple Organ Failure / Q000209:etiology / Q000517:prevention & control; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000097:blood / Q000150:complications*; D012772:Shock, Septic / Q000097:blood / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis
D000990:Antithrombin III; D011464:Epoprostenol