Reduction of D-dimer levels after therapeutic administration of antithrombin in acquired antithrombin deficiency of severe sepsis

Abstract

Introduction: In acute disseminated intravascular coagulation, the effect of antithrombin (AT) administration on elevated levels of D-dimer is not well established. In the present study, we report on changes in circulating levels of D-dimer in response to administration of AT in a series of patients with acquired AT deficiency due to severe sepsis.

Methods: Eight consecutive critically ill medical patients presenting with acute disseminated intravascular coagulation associated with severe sepsis/septic shock received a single bolus infusion of AT over 30 minutes, aiming to achieve physiological AT levels. Haemostatic parameters including D-dimer were assessed prior to, 6 and 24 h after AT administration. An average of 42 +/- 9 U/kg body weight was infused.

Results: Following AT substitution, elevated levels of D-dimer fell whereas AT levels rose.

Conclusion: These observations support the notion that AT can favourably affect fibrin degradation accompanying disseminated intravascular coagulation of severe sepsis.

Figure 1

Effect of antithrombin (AT) substitution on D-dimer levels (results are given as mean ± SEM, n = 6; patients receiving low-dose unfractioned heparin not included; *p < 0.05).

Figure 2

Effect of antithrombin (AT) on D-dimer levels in individual patients. D-dimer levels were assessed 4 to 6 h prior to, and 6 and 24 h after AT administration. Patients 7 and 8 were concomitantly receiving low-dose unfractioned heparin for continuous renal replacement therapy.