title: Efficacy and bleeding risk of antithrombin supplementation in septic disseminated intravascular coagulation: a prospective multicenter survey.
abstract: BACKGROUND
  Although supplementation with antithrombin (AT) concentrates has been widely accepted for the treatment of disseminated intravascular coagulation (DIC) in Japan, the effects and adverse effects have not been investigated.
  
  
  METHODS
  We conducted a nonrandomized multi-institutional survey. A total of 729 septic DIC patients with AT activity levels of 70% or lower, who had undergone AT substitution at either 1500 IU/day or 3000 IU/day for consecutive 3 days were analyzed. Of these, 650 and 79 patients had received 1500 IU/day (AT1500 group) and 3000 IU/day (AT3000 group), respectively.
  
  
  RESULTS
  Bleeding events were observed in 6.52% of patients (severe bleeding, 1.71%). A significant decrease in initial AT level (below 50%) was observed in 69.6% of patients in AT3000 group and 48.2% in AT1500 group, and this difference was significant (P<0.01). A logistic-regression analysis conducted using age, gender, body weight, initial AT activity, and supplemented AT dose, revealed that higher initial AT activity (odds ratio (OR), 1.032; P<0.001), AT dose of 3000 IU/day (OR, 1.912; P=0.026), and age (OR, 0.985; P=0.023) were significant factors for improved survival.
  
  
  CONCLUSIONS
  The risk of severe bleeding is less than 2%, and concomitant administration of heparin did not increase the risk. The survival in AT1500 group was 65.2%, while that in AT3000 group was 74.7%.
authors.affiliation: Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. toshiiba@cf6.so-net.ne.jp
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Iba
authors.forename: Daizo
authors.initials: D
authors.lastname: Saito
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.forename: Hidesaku
authors.initials: H
authors.lastname: Asakura
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000991:Antithrombins / Q000008:administration & dosage*; D015897:Comorbidity; D003625:Data Collection; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000401:mortality*; D064420:Drug-Related Side Effects and Adverse Reactions / Q000401:mortality*; D005260:Female; D006470:Hemorrhage / Q000401:mortality*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D018746:Systemic Inflammatory Response Syndrome / Q000188:drug therapy* / Q000401:mortality*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000991:Antithrombins