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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Treatment effects of high-dose antithrombin without concomitant heparin in patients with severe sepsis with or without disseminated intravascular coagulation
Journal of Thrombosis and Haemostasis, Volume 4, No. 1, Year 2006
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Description
Background: Disseminated intravascular coagulation (DIC) is a serious complication of sepsis that is associated with a high mortality. Object ives: Using the adapted International Society on Thrombosis and Haemostasis (ISTH) diagnostic scoring algorithm for DIC, we evaluated the treatment e.ects of high-dose antithrombin (AT) in patients with severe sepsis with or without DIC. Patients and Methods: From the phase III clinical trial in severe sepsis (KyberSept), 563 patients were identifed (placebo, 277; AT, 286) who did not receive concomitant heparin and had sufficient data for DIC determination. Results: At baseline, 40.7% of patients (229 of 563) had DIC. DIC in the placebo-treated patients was associated with an excess risk of mortality (28-day mortality: 40.0% vs. 22.2%, P < 0.01). AT-treated patients with DIC had an absolute reduction in 28-day mortality of 14.6% compared with placebo (P = 0.02) whereas in patients without DIC no e.ect on 28-day mortality was seen (0.1% reduction in mortality; P = 1.0). Bleeding complications in AT-treated patients with and without DIC were higher compared with placebo (major bleeding rates: 7.0% vs. 5.2% for patients with DIC, P = 0.6; 9.8% vs. 3.1% for patients without DIC, P = 0.02). Conclusions: High-dose AT without concomitant heparin in septic patients with DIC may result in a signifcant mortality reduction. The adapted ISTHDIC scoremay identify patient with severe sepsis who potentially benefit from high-dose AT treatment. © 2006 International Society on Thrombosis and Haemostasis.
Authors & Co-Authors
Kienast, Joachim
Germany, Munster
University of Münster
Juers, Mathias
Germany, Hattersheim
Zlb Behring Gmbh
Wiedermann, C. J.
Italy, Bolzano
Central Hospital of the Province of Bolzano
Hoffmann, Johannes N.
Germany, Munich
Klinikum Der Universität München
Ostermann, Helmut B.
Germany, Munich
Ludwig-maximilians-universität München
Strauss, Richard K.
Germany, Erlangen
Friedrich-alexander-universität Erlangen-nürnberg
Keinecke, Heinz Otto
Germany, Eschborn
Accovion Gmbh
Warren, Brian Leigh
South Africa, Stellenbosch
Stellenbosch University
Opal, Steven M.
United States, Pawtucket
Memorial Hospital of Rhode Island
Statistics
Citations: 388
Authors: 9
Affiliations: 9
Identifiers
Doi:
10.1111/j.1538-7836.2005.01697.x
ISSN:
15387933
e-ISSN:
15387836
Research Areas
Health System And Policy