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Antithrombin III for critically ill patients: a systematic review with meta-analysis and trial sequential analysis
Mikkel Allingstrup1,2, Jørn Wetterslev3, Frederikke B Ravn4
1Department of Anaesthesia, Køge Sygehus, Copenhagen University Hospital, Copenhagen, Denmark. mikkel.allingstrup@gmail.com.
Intensive Care Medicine
|February 11, 2016
Summary
Antithrombin III (AT III) did not significantly impact mortality in critically ill patients. However, AT III use was associated with a significant increase in bleeding events, suggesting caution is warranted.
Area of Science:
- Critical Care Medicine
- Pharmacology
- Hematology
Background:
- Antithrombin III (AT III) is an anticoagulant and anti-inflammatory agent.
- Its potential benefits in critically ill patients require thorough evaluation.
Purpose of the Study:
- To assess the benefits and harms of Antithrombin III (AT III) administration in critically ill patients.
- To evaluate the impact of AT III on mortality and bleeding events.
Main Methods:
- Systematic review and meta-analysis of 30 randomized controlled trials (RCTs).
- Included 3933 participants, irrespective of publication status, date, blinding, outcomes, or language.
- Searches conducted across multiple databases up to August 27, 2015.
Main Results:
- No statistically significant effect of AT III on overall mortality was observed (RR 0.95, 95% CI 0.88-1.03).
- AT III did not impact mortality in patients with severe sepsis and disseminated intravascular coagulation (DIC).
- A significant increase in bleeding events was associated with AT III use (RR 1.58, 95% CI 1.35-1.84).
Conclusions:
- Insufficient evidence supports the routine use of AT III in critically ill patients, including those with sepsis and DIC.
- While not affecting mortality, AT III significantly increases the risk of bleeding.
- Further high-quality research is needed to clarify the role of AT III in critical care.
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