Antithrombin after cardiac surgery: implications on short and mid-term outcome

Abstract

Low AT after cardiac surgery is associated with higher incidences of peri-operative complications and worse survival in the mid-term. Future studies should clarify the pathophysiologic mechanism of this findings and possible therapeutic directions.

Postoperative Costs Associated With Outcomes After Cardiac Surgery With Extracorporeal Circulation: Role of Antithrombin Levels

“…8 During these surgeries, the levels of AT activity decrease owing to consumption 9 and to hemodilution, 10 resulting in a deficient amount of this protein at the end of the procedure, 11,12 which has been associated with a worse clinical recovery after surgery. [13][14][15] Furthermore, in these studies, the patients with low levels of AT activity after CS remained in the ICU longer, with mechanical ventilation, and required more surgical re-explorations and blood transfusions. 14, 15 Paparella et al 14 showed that, after being admitted to the ICU, patients with AT activity levels Ͻ63.7% had a much greater incidence of adverse cardiac events, such as excessive bleeding, infections, stroke, acute renal failure, sepsis, and atrial fibrillation.…”

“…[13][14][15] Furthermore, in these studies, the patients with low levels of AT activity after CS remained in the ICU longer, with mechanical ventilation, and required more surgical re-explorations and blood transfusions. 14, 15 Paparella et al 14 showed that, after being admitted to the ICU, patients with AT activity levels Ͻ63.7% had a much greater incidence of adverse cardiac events, such as excessive bleeding, infections, stroke, acute renal failure, sepsis, and atrial fibrillation.…”

“…The costs derived from the postoperative management of outcomes also were identified and quantified in the meeting. The costs were calculated and compared by considering the AT levels of a patient after surgery (low Ͻ63.7% v normal Ն 63.7%), as defined by Paparella et al, 14 that have been reported to be related to the incidence of outcomes. The costs were allocated to the consumed resources by considering the unit costs for each based on the rates published by Spanish governmental agencies and official medical and pharmacy institutions.…”

“…The search yielded 70 articles, of which only 2 met the requirements: an article by Ranucci et al 15 that showed significant associations between the postoperative AT levels and the risk of postoperative complications and the article by Paparella et al 14 The latter article quantified this risk based on the results obtained by Ranucci et al, so that the patients they described as having low AT levels (Ͻ63.7%) presented higher risk of complications than the patients with normal levels (Ն63.7%). The other articles were excluded because they did not describe the relation between AT levels and the risk of postoperative complications.…”

“…To characterize the use of resources associated with postoperative management in CS with ECC, the results obtained from the literature were complemented with a structured questionnaire based on the studies by Ranucci et al 15 and Paparella et al 14 and a reference manual of CS postoperative management. 1 The questionnaire was sent by electronic mail to a group of expert anesthesiologists in public hospitals representing the Spanish public health care system.…”