Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis
Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis
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DOI：
10.1186/cc5098
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发表时间：
2006-01-01
期刊：
影响因子：
15.1
通讯作者：
Kettner, Stephan C.
中科院分区：
文献类型：
--
作者：
Gonano, Christopher;Sitzwohl, Christian;Kettner, Stephan C.
脓毒症激活凝血系统，经常导致高凝状态，这是不能检测到的常规凝血试验。血栓弹力图（TEG）是评价高凝状态的可靠方法，但迄今为止尚未用于研究脓毒症引起的高凝状态。脓毒症患者血浆中抗凝血酶（AT）降低，因此给予AT可降低获得性高凝状态。然而，尚不清楚在何种程度上超生理血浆AT水平降低脓毒症患者的急性高凝状态。本研究调查脓毒症患者的凝血概况之前和4天期间的高剂量AT therapy.Methods严重脓毒症患者被随机分配到要么接受6,000 IU AT作为一个团注输注，然后维持剂量为250 IU/小时超过4天（n = 17）或安慰剂（n = 16）。结果两组患者治疗前TEG均呈高凝状态，单次静脉推注或维持剂量的AT均不能逆转TEG的高凝状态。高凝状态主要是由血浆纤维蛋白原升高引起的，其次是血小板。血浆凝血评估的凝血酶原时间和活化部分凝血活酶时间是相似的，在这两个群体，并没有改变在studyperiod.Conclusion目前的研究表明，在严重脓毒症，这是不扭转高剂量AT治疗超过四天的患者明显的高凝状态。这一发现支持了最近的数据显示，在脓毒症患者中，AT对凝血激活的调节在治疗一周前不会发生。
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.