Antithrombin III and local serum application: adjuvant therapy in peritonitis

Area of Science:

• Critical Care Medicine
• Surgical Infections
• Immunomodulation

Background:

• Diffuse peritonitis presents a high mortality risk (approx. 20%) due to compromised local defenses and systemic bacterial/toxin spread, often leading to sepsis.
• Sepsis syndrome and multiple organ failure (MOF) are critical complications in patients with diffuse peritonitis.

Purpose of the Study:

• To evaluate the efficacy of adjuvant therapy with antithrombin III and fresh frozen human donor serum in reducing mortality and MOF in diffuse secondary peritonitis.
• To assess the feasibility and safety of this therapeutic approach.

Main Methods:

• A prospective, randomized, controlled study involving 50 patients with diffuse secondary peritonitis.
• Therapy group received continuous intravenous antithrombin III infusion and two intraperitoneal instillations of fresh frozen human donor serum.
• Control group received standard care.

Main Results:

• Antithrombin III plasma levels were significantly elevated in the therapy group compared to controls.
• Intraperitoneal administration of fresh frozen serum and antithrombin III enhanced opsonic capacity and thrombin inhibitory activity in peritoneal exudate.
• No significant reduction in 90-day mortality was observed (23% control vs. 25% therapy).
• A non-significant trend towards reduced MOF severity was noted.

Conclusions:

• The adjuvant therapy regimen was feasible and well-tolerated, with no observed side-effects.
• Short-term administration of antithrombin III and fresh frozen serum did not significantly improve mortality or reduce MOF in diffuse peritonitis.
• Future research should consider longer treatment durations and combinations with other anti-inflammatory agents for severely ill patients.