Antithrombin Administration in Patients With Low Antithrombin Values After Cardiac Surgery: A Randomized Controlled Trial

The Rise and Fall of Antithrombin Supplementation in Cardiac Surgery

“…The tests for heterogeneity and publication bias carry a P value of .81 and .79, respectively. Of interest, the definition of AKI was similar in the 3 studies: peak serum creatinine level >2 mg/dL and twice the baseline 8 ; new onset of postoperative serum creatinine level >2 mg/dL or twice the baseline or need for renal replacement therapy 9 ; increase of serum creatinine concentration to >2.0 mg/dL and a doubling of the baseline creatinine concentration, or a new requirement for dialysis postoperatively. 1 Overall, these definitions are configuring a stage 2 to 3 of AKI according to the Kidney Disease Improving Global Outcomes (KDIGO) definition.…”

Antithrombin Replacement in Cardiac Surgery: Was Too Much of a Good Thing Bad?

“…10 Notably, the dose of antithrombin administered in KyberSept was significantly higher, and dosing was repeated over multiple days (30,000 international units over 4 days) compared to the cardiac surgical RCTs, in which doses were 2000 to 5000 international units. 11,12 In their review, Ranucci et al concluded that antithrombin supplementation may increase the incidence of acute kidney injury after cardiac surgery by as much as 3-to 4-fold. The authors provide a pooled odds ratio (OR) for acute kidney injury based on findings from RCTs (OR, 4.41; 95% [confidence interval] CI, 1.90-10.23).…”

“…10 Notably, the dose of antithrombin administered in KyberSept was significantly higher, and dosing was repeated over multiple days (30,000 international units over 4 days) compared to the cardiac surgical RCTs, in which doses were 2000 to 5000 international units. 11,12…”

Outcome measures and quality markers for perioperative blood loss and transfusion in cardiac surgery

“…The amount of perioperative bleeding was defined in a heterogeneous way, either as a primary or (more frequently) secondary endpoint of the study. The following treatments have recently been evaluated for efficacy in reducing perioperative bleeding: use of transfusion algorithms based on point of care, 15 fibrinogen concentrate, 9,10,16,17 tranexamic acid/epsilonaminocaproic acid, [18][19][20] antithrombin-III, 21 heparin monitoring systems, 22 and shed blood processing. 23,24 Notably, the objective for all these treatments was a direct reduction in postoperative bleeding; however, in the majority of the cases, the primary endpoint was avoidance of transfusion.…”