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Antithrombin III for critically ill patients.

Mikkel Allingstrup1, Jørn Wetterslev, Frederikke B Ravn

  • 1Department of Anaesthesia, Køge Sygehus, Copenhagen University Hospital, Copenhagen, Denmark.

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|February 10, 2016
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Summary
This summary is machine-generated.

Antithrombin III (AT III) supplementation does not significantly impact mortality in critically ill patients. However, AT III use is associated with an increased risk of bleeding events, necessitating further research with robust trial designs.

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Area of Science:

  • Critical care medicine
  • Pharmacology
  • Evidence-based medicine

Background:

  • Critical illness involves inflammation and vascular damage, potentially leading to organ failure.
  • Antithrombin III (AT III) possesses anticoagulant and anti-inflammatory properties.
  • The efficacy and safety of AT III supplementation in critically ill patients remain unclear.

Purpose of the Study:

  • To evaluate the effect of AT III on mortality in critically ill patients.
  • To assess the benefits and harms associated with AT III supplementation.
  • To investigate complications, bleeding events, sepsis, DIC, and length of stay.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs).
  • Searched multiple databases up to August 2015, including unpublished abstracts.
  • Extracted data independently, performed subgroup analyses, and conducted trial sequential analysis.

Main Results:

  • AT III showed no statistically significant effect on mortality (RR 0.95, 95% CI 0.88-1.03).
  • A statistically significant increase in bleeding events was observed (RR 1.58, 95% CI 1.35-1.84).
  • No significant benefits were found in subgroup analyses; evidence quality was mostly low to very low.

Conclusions:

  • Insufficient evidence supports AT III substitution in critically ill patients, including those with sepsis and DIC.
  • AT III increased the risk of bleeding without a significant impact on mortality.
  • A large, well-designed RCT is needed to clarify the role of AT III in critical care.