title: Antithrombin administration in patients with low antithrombin values after cardiac surgery: a randomized controlled trial.
abstract: BACKGROUND
  Antithrombin (AT) concentrations are reduced after cardiac surgery with cardiopulmonary bypass compared with the preoperative levels. Low postoperative AT is associated with worse short- and mid-term clinical outcomes. The aim of the study is to evaluate the effects of AT administration on activation of the coagulation and fibrinolytic systems, platelet function, and the inflammatory response in patients with low postoperative AT levels.
  
  
  METHODS
  Sixty patients with postoperative AT levels of less than 65% were randomly assigned to receive purified AT (5000 IU in three administrations) or placebo in the postoperative intensive care unit. Thirty patients with postoperative AT levels greater than 65% were observed as controls. Interleukin 6 (a marker of inflammation), prothrombin fragment 1-2 (a marker of thrombin generation), plasmin-antiplasmin complex (a marker of fibrinolysis), and platelet factor 4 (a marker of platelet activation) were measured at six different times.
  
  
  RESULTS
  Compared with the no AT group and control patients, patients receiving AT showed significantly higher AT values until 48 hours after the last administration. Analysis of variance for repeated measures showed a significant effect of study treatment in reducing prothrombin fragment 1-2 (p=0.009; interaction with time sample, p=0.006) and plasmin-antiplasmin complex (p<0.001; interaction with time sample, p<0.001) values but not interleukin 6 (p=0.877; interaction with time sample, p=0.521) and platelet factor 4 (p=0.913; interaction with time sample, p=0.543). No difference in chest tube drainage, reopening for bleeding, and blood transfusion was observed.
  
  
  CONCLUSIONS
  Antithrombin administration in patients with low AT activity after surgery with cardiopulmonary bypass reduces postoperative thrombin generation and fibrinolysis with no effects on platelet activation and inflammatory response.
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy. Electronic address: domenico.paparella@uniba.it.
authors: Domenico
authors: D
authors: Paparella
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Crescenzia
authors: C
authors: Rotunno
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Micaela
authors: M
authors: De Palo
authors: Division of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Simona
authors: S
authors: Finamore
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Pietro
authors: P
authors: Guida
authors: Division of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Gianni
authors: G
authors: Rubino
authors: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Luigi
authors: L
authors: de Luca Tupputi Schinosa
authors: Division of Anesthesia, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors: Tommaso
authors: T
authors: Fiore
mesh_terms: D000368:Aged; D000991:Antithrombins / Q000097:blood* / Q000627:therapeutic use*; D002315:Cardiopulmonary Bypass; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D000991:Antithrombins