Abstract
Objective
Since antithrombin III (AT III) substitution to normal activities could not be shown to have major beneficial effects in patients with end-stage chronic liver disease in a variety of clinical settings, we tested the hypothesis that substitution to supranormal activities decreases systemic procoagulant turnover better in this patient group.
Design
Controlled prospective clinical study.
Setting
Operating rooms at a University Hospital.
Patients
Twenty-four patients with histologically verified liver cirrhosis consecutively scheduled for liver transplantation.
Interventions
Nineteen patients were given an antithrombin III concentrate to achieve either 100 % (n=10) or 175 % (n=9) AT III activity. Control patients (n=5) received saline 0.9 % instead.
Measurements and results
Molecular markers of coagulation activation, platelet count and aggregability, and global coagulation variables were measured prior to AT III infusion and 60 min thereafter. In both AT Illtreated groups throm binantithrombin Illcomplex increased significantly (p<0.005), whereas prothrombin fragment Fl + 2, soluble fibrin and D-dimer concentrations, as well as other variables, did not show major char ges.
Conclusions
Despite thrombin in hibition by AT III in patients wit end-stage chronic liver disease, systemic procoagulant turnover was not significantly decreased 60 min after AT III application even to supranormal activities. Replenishment of the inhibitory antithrombin III pool, decreased in chronic liver disease, should not be expected to slow down the baseline con sumptive component of the haemostatic disorder in this patient group.
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This study was supported by the Department of Anesthesiology and Intensive Care Medicine, and the Department of General Surgery, University Hospital Essen, Germany
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Scherer, R., Kabatnik, M., Erhard, J. et al. The influence of antithrombin III (AT III) substitution to supranormal activities on systemic procoagulant turnover in patients with end-stage chronic liver disease. Intensive Care Med 23, 1150–1158 (1997). https://doi.org/10.1007/s001340050472
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DOI: https://doi.org/10.1007/s001340050472