title: Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis.
abstract: BACKGROUND
  Sepsis activates the coagulation system and frequently causes hypercoagulability, which is not detected by routine coagulation tests. A reliable method to evaluate hypercoagulability is thromboelastography (TEG), but this has not so far been used to investigate sepsis-induced hypercoagulability. Antithrombin (AT) in plasma of septic patients is decreased, and administration of AT may therefore reduce the acquired hypercoagulability. Not clear, however, is to what extent supraphysiologic plasma levels of AT decrease the acute hypercoagulability in septic patients. The present study investigates the coagulation profile of septic patients before and during four day high-dose AT therapy.
  
  
  METHODS
  Patients with severe sepsis were randomly assigned to receive either 6,000 IU AT as a bolus infusion followed by a maintenance dose of 250 IU/hour over four days (n = 17) or placebo (n = 16). TEG, platelet count, plasma fibrinogen levels, prothrombin time and activated partial thromboplastin time were assessed at baseline and daily during AT therapy.
  
  
  RESULTS
  TEG showed a hypercoagulability in both groups at baseline, which was neither reversed by bolus or by maintenance doses of AT. The hypercoagulability was mainly caused by increased plasma fibrinogen, and to a lesser extent by platelets. Plasmatic coagulation as assessed by the prothrombin time and activated partial thromboplastin time was similar in both groups, and did not change during the study period.
  
  
  CONCLUSIONS
  The current study shows a distinct hypercoagulability in patients suffering from severe sepsis, which was not reversed by high-dose AT treatment over four days. This finding supports recent data showing that modulation of coagulatory activation in septic patients by AT does not occur before one week of therapy.
authors.affiliation: Department of Anesthesiology and General Intensive Care, Medical University of Vienna, Waehringer Gürtel 18-20, A-1090 Vienna, Austria. christopher.gonano@meduniwien.ac.at
authors.forename: Christopher
authors.initials: C
authors.lastname: Gonano
authors.forename: Christian
authors.initials: C
authors.lastname: Sitzwohl
authors.forename: Eva
authors.initials: E
authors.lastname: Meitner
authors.forename: Christian
authors.initials: C
authors.lastname: Weinstabl
authors.forename: Stephan C
authors.initials: SC
authors.lastname: Kettner
mesh_terms: D000328:Adult; D000368:Aged; D000991:Antithrombins / Q000494:pharmacology / Q000627:therapeutic use*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D018805:Sepsis / Q000150:complications*; D019851:Thrombophilia / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000991:Antithrombins; D005340:Fibrinogen