[Antithrombin therapy of no value in sepsis according to a large clinical trial].
Antithrombin has been used for over two decades as adjuvant therapy in severe sepsis, especially when associated with coagulopathy. A positive effect has been demonstrated in several experimental sepsis models and a number of small clinical trials have suggested a beneficial effect. A large confirmatory randomized clinical trial with 2,314 evaluable patients with severe sepsis was recently completed [1]. No treatment effect of antithrombin was demonstrated (28 day overall mortality was 38.9% and 38.7% in the treatment and placebo groups, respectively). Among various secondary effect and subgroup analyses, it is noteworthy that no trend indicating a beneficial effect of antithrombin substitution was found even in the subgroup of patients with plasma levels of antithrombin < 60% on randomization (n = 1,117). In summary, there is presently no support for the general use of antithrombin as adjuvant therapy in severe sepsis/septic shock.
Gårdlund
Bengt
B
Infektionskliniken, Karolinska sjukhuset, Stockholm. bengt.gardlund@ks.se
D000818:Animals; D000925:Anticoagulants / Q000008:administration & dosage*; D000990:Antithrombin III / Q000008:administration & dosage*; D017326:Clinical Trials, Phase III as Topic; D006801:Humans; D015337:Multicenter Studies as Topic; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000188:drug therapy* / Q000401:mortality; D015842:Serine Proteinase Inhibitors / Q000008:administration & dosage*; D012772:Shock, Septic / Q000188:drug therapy / Q000401:mortality; D016896:Treatment Outcome
D000925:Anticoagulants; D015842:Serine Proteinase Inhibitors; D000990:Antithrombin III