Original

Intensive Care Medicine

, Volume 24, Issue 4, pp 336-342

Antithrombin III (ATILL) replacement therapy in patients with sepsis and/or postsurgical complications: a controlled double-blind, randomized, multicenter study

  • F. BaudoAffiliated withDepartment of Hematology, Hemostasis and Thrombosis Unit, Ospedale Niguarda Email author 
  • , T. M. CaimiAffiliated withDepartment of Hematology, Hemostasis and Thrombosis Unit, Ospedale Niguarda
  • , F. deCataldoAffiliated withDepartment of Hematology, Hemostasis and Thrombosis Unit, Ospedale Niguarda
  • , A. RavizzaAffiliated withDepartment of Intensive Care, Ospedale Niguarda
  • , S. ArlatiAffiliated withDepartment of Intensive Care, Ospedale Niguarda
  • , G. CasellaAffiliated withDepartment of Intensive Care, Ospedale Niguarda
  • , D. CarugoAffiliated withDepartment of Intensive Care, Ospedale Niguarda
  • , G. PalaretiAffiliated withDepartment of Angiology, Ospedale S. Orsola
  • , C. LegnaniAffiliated withDepartment of Angiology, Ospedale S. Orsola
    • , L. RidolfiAffiliated withDepartment of Intensive Care, Ospedale S. Orsola
    • , R. RossiAffiliated withDepartment of Intensive Care, Ospedale S. Orsola
    • , A. D’AngeloAffiliated withHemostasis Laboratory, Ospedale S. Raffaele
    • , L. CrippaAffiliated withHemostasis Laboratory, Ospedale S. Raffaele
    • , D. GiudiciAffiliated withIntensive Care Unit, Ospedale S. Raffaele
    • , G. GallioliAffiliated withIntensive Care Unit, Ospedale S. Raffaele
    • , A. WolflerAffiliated withIntensive Care Unit, Ospedale S. Raffaele
    • , G. CaloriAffiliated withEpidemiology Unit, Ospedale S. Raffaele

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Abstract

Background: ATIII is decreased in sepsis and/or shock and its baseline value correlates with mortality. The efficacy of ATIII therapy on mortality was assessed in a selected group of patients admitted to the intensive care unit (ICU) in a double-blind, randomized, multicenter study.

Methods: 120 patients admitted to the ICU with an ATIII concentration < 70% were randomized to receive ATIII (total dose 24000 units) or placebo treatment for 5 days; 56 patients had septic shock.

Results: ATIII concentrations in the treated group remained constant throughout the treatment period (range 97–102%). The Kaplan-Meier analysis showed no difference in overall survival between the two groups: 50 and 46 % for ATIII and placebo, respectively. Septic shock and hemodynamic support were unbalanced in the two groups at admission. Therefore the Cox analysis was carried out after adjusting for these two variables. Treatment with ATIII decreases the risk of death with an odds ratio (OR) of 0.56. Of the covariates analyzed, septic shock and the baseline multiple organ failure score were negatively associated with survival and plasma activity level was positively associated with survival with an OR of 0.97 for each 1 % increase in the ATIII plasma concentration at baseline.

Conclusions: The results of ATIII treatment in this population of patients suggests that replacement therapy reduces mortality in the subgroup of septic shock patients only.

Keywords

Acquired ATIII deficiency ATIII replacement therapy Septic shock