Antithrombin III in Sepsis. New evidences and open questions

Antithrombin III (ATIII) has been found to be a marker for DIC and to be of prognostic significance in septic patients. Several studies have shown that administration of ATIII in patients with sepsis related DIC is effective in shortening the duration of DIC. Despite a meta-analysis of randomized controlled trials have shown a significant reduction in 28-day mortality, a prospective randomized double-blind placebo-controlled trial failed to show a significant improvement in overall survival. However the concomitant use of heparin, which does not seem to have an additional beneficial effect, may have obscured the efficacy of ATIII. More studies are needed to understand mechanism of action of ATIII and better define patient population that may benefit from ATIII.