Related Experiment Video
Updated: May 22, 2026
The Nijmegen Hemostasis Assay: Simultaneous Fluorogenic Measurement of Thrombin and Plasmin Generation in a Single Well
Published on: February 27, 2026
Efficacy and bleeding risk of antithrombin supplementation in septic disseminated intravascular coagulation: a
Toshiaki Iba1, Daizo Saito, Hideo Wada
1Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. toshiiba@cf6.so-net.ne.jp
Insights
Higher doses of antithrombin (AT) concentrate improved survival in septic patients with disseminated intravascular coagulation (DIC). Severe bleeding risk remained low, with no increased risk when heparin was co-administered.
Area of Science:
- Critical Care Medicine
- Hematology
- Pharmacology
Background:
- Antithrombin (AT) concentrate supplementation is standard for disseminated intravascular coagulation (DIC) in Japan.
- However, its efficacy and safety profile require further investigation.
Purpose of the Study:
- To evaluate the effects and adverse events of different antithrombin (AT) concentrate dosages in patients with septic DIC.
- To identify factors influencing survival rates in these patients.
Main Methods:
- A nonrandomized, multi-institutional survey analyzed 729 septic DIC patients with AT activity ≤70%.
- Patients received either 1500 IU/day (AT1500 group, n=650) or 3000 IU/day (AT3000 group, n=79) of AT for 3 consecutive days.
Main Results:
- Severe bleeding occurred in 1.71% of patients; concomitant heparin did not increase bleeding risk.
- AT3000 group showed a significantly higher decrease in initial AT levels (below 50%) compared to the AT1500 group (69.6% vs. 48.2%, P<0.01).
- Higher initial AT activity, AT dose of 3000 IU/day, and older age were significant factors for improved survival.
Conclusions:
- Antithrombin concentrate supplementation is associated with a low risk of severe bleeding (<2%) in septic DIC.
- The 3000 IU/day AT dosage demonstrated higher survival rates (74.7%) compared to the 1500 IU/day dosage (65.2%).
Introduction:
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.
Materials And 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.
Conclusion:
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%.
Related Concept Videos
01:29Venous Thrombosis III: Interprofessional Care
01:30Anticoagulant Drugs: Low-Molecular-Weight Heparins
01:18Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
01:30Venous Thrombosis IV: Nursing Management
01:20Venous Thrombosis II: Clinical Manifestations and Diagnostic Studies
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care