The role of antithrombin III in the perioperative management of the patient with unstable angina.
BACKGROUND
To evaluate the effectiveness of intraoperative administration of antithrombin III (AT III) to improve anticoagulation and preserve the hemostatic mechanisms during cardiopulmonary bypass (CPB) in patients with unstable angina under heparin treatment.


METHODS
We divided 22 patients, scheduled for coronary artery bypass grafting, into two groups. Group A (11 patients) received 3000 International Units (IU) of AT III concentrates plus heparin before aortic cannulation. Group B (11 patients) received only heparin. Blood drainage, allogeneic blood transfusions, and intraoperative activated coagulation time were recorded. Also, AT III, thrombin-antithrombin complex (TAT), fragment 1.2 (F 1.2), and D-dimers were measured during the operation and the first postoperative day.


RESULTS
Group A patients had fewer transfusions and had less chest-tube drainage. In group A, AT III levels increased after AT III concentrates administration and were always higher than in group B. In group B, F 1.2 and TAT increased significantly more after CPB and at the end of operation. Differences in D-dimers between the groups were not significant.


CONCLUSIONS
Intraoperative administration of AT III concentrates allowed adequate anticoagulation during CPB and attenuated the coagulative cascade activation and the consequent consumptive coagulopathy.
Rossi
M
M
Department of Anesthesia and Critical Care, Catholic University of the Sacred Heart, Rome, Italy. mrossi@edl.it
Martinelli
L
L
Storti
S
S
Corrado
M
M
Marra
R
R
Varano
C
C
Schiavello
R
R
D000789:Angina, Unstable / Q000601:surgery*; D000925:Anticoagulants / Q000008:administration & dosage; D000990:Antithrombin III / Q000008:administration & dosage* / Q000032:analysis; D001803:Blood Transfusion; D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006400:Hematocrit; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000032:analysis; D010447:Peptide Hydrolases / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D011517:Prothrombin Time; D014914:Whole Blood Coagulation Time
D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; C046193:antithrombin III-protease complex; C036309:fibrin fragment D; C045879:prothrombin fragment 1.2; D000990:Antithrombin III; D011516:Prothrombin; D006493:Heparin; D010447:Peptide Hydrolases