Impact of withdrawing antithrombin III administration from management of septic patients with or without disseminated intravascular coagulation

Abstract

Antithrombin III (ATIII) of low doses (1500-3000 units per day for 3-5 days) has been used for treatment of disseminated intravascular coagulation (DIC) for decades in Japan. In this study, we have examined the impact of ATIII practice change on outcome in critically ill patients with sepsis and DIC. From April 2005 to September 2008, all septic patients admitted to our ICU were divided into two groups: before withdrawing ATIII (period 1) and after withdrawing ATIII (period 2). Patients treated with ATIII in the period 1 and those not treated with ATIII in the period 2 were then matched according to the similar Acute Physiology and Chronic Health Evaluation II scores (± 3) and the same diagnosis grouping. Sensitivity analysis was also conducted for patients with DIC. Forty-one out of 98 patients (41.8%) in the period 1 and only one out of 80 patients (1.3%) in the period 2 were treated with ATIII. Thirty pairs of the patients were matched. There was no difference between the two groups regarding the platelet counts and Sepsis-related Organ Failure Assessment scores at day 1 and day 4. A subgroup analysis was conducted with 12 patients diagnosed with DIC out of the 30 pairs. There was no difference between the two DIC groups for platelet counts, Sepsis-related organ failure assessment scores and DIC score at day 1 and also day 4. Although not significant, hospital mortality tended lower in the period 2. This study found that withdrawing ATIII administration from management of septic patients with or without DIC did not influence outcome.

Supplemental dose of antithrombin use in disseminated intravascular coagulation patients after abdominal sepsis

“…Categorical variables were compared using the χ2 test or Fisher's exact test. study, a patient's receipt of antithrombin may have been determined more strongly by the hospital at which the patient was treated than by their individual characteristics (9,18,22,24,34). In such a situation, the hospital's preference for antithrombin may have acted as an instrumental variable, thereby setting the stage for a "natural experiment" that allows an unbiased estimate of the risk of DIC, even if unmeasured confounding factors exist (22).…”