[Use of antithrombin III concentrates]

Area of Science:

• Biochemistry
• Hematology
• Critical Care Medicine

Background:

• Antithrombin III (AT III) deficiency can be congenital or acquired.
• Congenital AT III deficiency typically requires substitution during surgery or pregnancy.
• Oral anticoagulants are often sufficient for thrombosis prophylaxis in congenital cases.

Purpose of the Study:

• To evaluate the efficacy of AT III concentrate in acquired AT III deficiency, especially in disseminated intravascular coagulation (DIC).
• To assess the impact of AT III substitution on DIC duration and survival rates in septic shock.
• To determine the benefit of additional heparin administration in conjunction with AT III substitution.

Main Methods:

• Administration of antithrombin III (AT III) concentrates in patients with acquired AT III deficiency and DIC.
• Maintaining AT III activity around 100% during treatment.
• Comparison of outcomes with and without AT III substitution, including in cases of septic shock.
• Evaluation of the effect of concurrent heparin administration.

Main Results:

• AT III substitution considerably shortened the duration of DIC in acquired deficiency.
• No additional benefit was observed with the concurrent administration of heparin.
• In DIC due to septic shock, AT III substitution increased survival rates from approximately 20% to over 70%.

Conclusions:

• Antithrombin III (AT III) concentrate is a valuable therapeutic option for acquired AT III deficiency, especially in advanced DIC.
• AT III substitution therapy significantly improves survival in patients with septic shock-induced DIC.
• Heparin does not appear to offer additional benefits when used with AT III substitution in DIC.