title: Activated protein C retards recovery from coagulopathy in severe acute pancreatitis.
abstract: OBJECTIVE
  Activated protein C (APC), an endogenous anticoagulant, has antithrombotic, fibrinolytic and anti-inflammatory properties. We recently conducted a controlled study (APCAP, activated protein C in severe acute pancreatitis) of APC treatment of patients with severe acute pancreatitis (SAP). Here we studied the effect of APC on the pivotal coagulation parameters of the surviving patients in the APCAP study.
  
  
  METHODS
  The study consisted of 20 patients of whom 10 patients had received APC and 10 patients had received placebo. Coagulation parameters, physiological anticoagulants, thrombograms and circulating levels of IL-6 and CRP were determined on admission and at days 1, 3-4 and 6-7.
  
  
  RESULTS
  During follow-up, the temporal levels of prothrombin time (PT) decreased and the temporal levels of thromboplastin time (TT) increased in placebo group (p< 0.001 for both), but not in APC group. The temporal levels of antithrombin (AT) increased less in APC group than in placebo group (p = 0.011). The shapes of the SAP patients' thrombograms were strongly deranged and were marginally affected by APC treatment.
  
  
  CONCLUSIONS
  Coagulopathy in SAP, a complex phenomenon, is not alleviated by APC treatment. Rather, the patients receiving APC are heading toward normal homeostasis of coagulation slower than patients receiving placebo.
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Lea
authors.initials: L
authors.lastname: Kyhälä
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Outi
authors.initials: O
authors.lastname: Lindström
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Leena
authors.initials: L
authors.lastname: Kylänpää
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Harri
authors.initials: H
authors.lastname: Mustonen
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Pauli
authors.initials: P
authors.lastname: Puolakkainen
authors.affiliation: a Department of Surgery , University of Helsinki and Helsinki University Hospital , Helsinki .
authors.forename: Esko
authors.initials: E
authors.lastname: Kemppainen
authors.affiliation: b Intensive Care Units, Department of Anesthesia and Intensive Care Medicine , Helsinki University Central Hospital , Helsinki .
authors.forename: Minna
authors.initials: M
authors.lastname: Tallgren
authors.affiliation: b Intensive Care Units, Department of Anesthesia and Intensive Care Medicine , Helsinki University Central Hospital , Helsinki .
authors.forename: Ville
authors.initials: V
authors.lastname: Pettilä
authors.affiliation: c Department of Bacteriology and Immunology , the Haartman Institute, University of Helsinki , Helsinki , and.
authors.forename: Heikki
authors.initials: H
authors.lastname: Repo
authors.affiliation: d Department of Gynecology and Pediatrics , Helsinki University Central Hospital , Helsinki , Finland.
authors.forename: Jari
authors.initials: J
authors.lastname: Petäjä
mesh_terms: D000208:Acute Disease; D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D058833:Antithrombin Proteins / Q000032:analysis; D001778:Blood Coagulation Disorders / Q000097:blood / Q000209:etiology; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D010314:Partial Thromboplastin Time; D011486:Protein C / Q000009:adverse effects / Q000627:therapeutic use*; D011517:Prothrombin Time
chemical_list: D000925:Anticoagulants; D058833:Antithrombin Proteins; C508600:IL6 protein, human; D015850:Interleukin-6; D011486:Protein C
keywords: Protein C system; antithrombins; coagulation factors; fibrinogen; pancreatitis