Antithrombin III in hematopoietic stem cell transplantation

Many of the serious, potentially fatal complications of hematopoietic stem cell transplantation have similarities to the multiple organ dysfunction syndrome (MODS) in critically ill nontransplant patients. One of these similarities is the alteration in the hemostatic system in such a way as to lower the levels of the naturally occurring anticoagulant proteins, especially antithrombin III. As in MODS, the outcome of transplant patients with these complications correlates with the degree of change in antithrombin III levels. Preliminary studies suggest that antithrombin III concentrate in pharmacologic doses along with intensive supportive care efforts can improve the clinical outcome of patients with these transplant-related complications. Further work to confirm these findings and, it is hoped, provide insight into the mechanism of action of antithrombin III in this setting is obviously warranted. Until such studies are completed, however, the preponderance of evidence suggests that when subjected to a risk-benefit analysis, patients in the early stages of transplant-related complications would be better off receiving antithrombin III supplementation than not.