[Severe sepsis and disseminated intravascular coagulation. Supplementation with antithrombin].
Administration of high-dose antithrombin (AT) was investigated on a large collective of patients with severe sepsis in the KyberSept study. In the total study the administration of AT resulted in no significant reduction of the mortality rate in comparison to a placebo. However, in the protocol of this study subgroups were predefined, which when analyzed revealed that the group of patients who received AT but not simultaneously heparin did show a reduction of the mortality rate in comparison to the placebo group. The reduction of the absolute mortality rate of 15% reached statistical significance on day 90. Even patients classified as risk group grade II according to the Simplified Acute Physiology Score (SAPS), showed a significant reduction of the mortality rate of approximately 22% after 90 days without simultaneous administration of heparin. Such a positive result for administration of AT without simultaneous heparin treatment can also be found when severe sepsis complicated by disseminated intravascular coagulation (DIC) is present. Coagulation diagnostic assists the recognition of latent or fulminant DIC and also in surveillance of the course and development. The results of AT supplementation for severe sepsis and DIC are in agreement with earlier studies on smaller patient collectives and suggest that a randomized controlled clinical study should be carried out on a subcollective of severely ill patients.
Angstwurm
M
M
Medizinische Klinik, Ziemssenstr. 1, 80336 München, Deutschland. matthias.angstwurm@med.uni-muenchen.de
Hoffmann
J
J
Ostermann
H
H
Frey
L
L
Spannagl
M
M
D000991:Antithrombins / Q000009:adverse effects / Q000627:therapeutic use*; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D018570:Risk Assessment; D018805:Sepsis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*
D000991:Antithrombins; D005343:Fibrinolytic Agents; D006493:Heparin