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Critical Care
Published in: Critical Care 6/2006

Open Access 01-12-2006 | Research

Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis

Authors: Christopher Gonano, Christian Sitzwohl, Eva Meitner, Christian Weinstabl, Stephan C Kettner

Published in: Critical Care | Issue 6/2006

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Abstract

Introduction

Sepsis activates the coagulation system and frequently causes hypercoagulability, which is not detected by routine coagulation tests. A reliable method to evaluate hypercoagulability is thromboelastography (TEG), but this has not so far been used to investigate sepsis-induced hypercoagulability. Antithrombin (AT) in plasma of septic patients is decreased, and administration of AT may therefore reduce the acquired hypercoagulability. Not clear, however, is to what extent supraphysiologic plasma levels of AT decrease the acute hypercoagulability in septic patients. The present study investigates the coagulation profile of septic patients before and during four day high-dose AT therapy.

Methods

Patients with severe sepsis were randomly assigned to receive either 6,000 IU AT as a bolus infusion followed by a maintenance dose of 250 IU/hour over four days (n = 17) or placebo (n = 16). TEG, platelet count, plasma fibrinogen levels, prothrombin time and activated partial thromboplastin time were assessed at baseline and daily during AT therapy.

Results

TEG showed a hypercoagulability in both groups at baseline, which was neither reversed by bolus or by maintenance doses of AT. The hypercoagulability was mainly caused by increased plasma fibrinogen, and to a lesser extent by platelets. Plasmatic coagulation as assessed by the prothrombin time and activated partial thromboplastin time was similar in both groups, and did not change during the study period.

Conclusion

The current study shows a distinct hypercoagulability in patients suffering from severe sepsis, which was not reversed by high-dose AT treatment over four days. This finding supports recent data showing that modulation of coagulatory activation in septic patients by AT does not occur before one week of therapy.
Trial registration: Current Control Trials ISRCTN22931023
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Metadata
Title
Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis
Authors
Christopher Gonano
Christian Sitzwohl
Eva Meitner
Christian Weinstabl
Stephan C Kettner
Publication date
01-12-2006
Publisher
BioMed Central
Published in
Critical Care / Issue 6/2006
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc5098

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