Clinical trial results with antithrombin III in sepsis

Objective: To present and discuss the rationale and results of clinical tri als using antithrombin (AT) supplementation in patients with sepsis. Data Sources/Study Selection: Review of all controlled (open or double-blin d) studies of patients with severe sepsis or septic shock who were treated with AT concentrates to obtain better control of coagulation activation and inflammation. Data Extraction: AT is a major inhibitor of the coagulation cascade. Recent experimental studies have also shown that it can modulate the inflammatory reactions that occur during sepsis. An early and prolonged decrease in AT activity is well documented during sepsis-induced disseminated intravascula r coagulation and during the systemic inflammatory response. Thus, suppleme ntation with AT concentrates has been proposed as a potential therapy in se psis patients. Data Synthesis: Numerous uncontrolled studies of AT supplementation in seps is patients have been reported in the last 20 yrs. Since 1993, four placebo -controlled randomized studies have been performed in France, Germany, Nort hwestern Europe, and Italy. Three of these studies were subjected to a meta -analysis of 122 patients. Results showed a nonsignificant 22% reduction in the 30-day all-cause mortality and a reduction in the length of stay in th e intensive care unit in the AT treated group. The Italian study of 120 pat ients demonstrated that the overall mortality was similar in the placebo an d treated groups. However, post hoc analysis according to the Cox regressio n model showed that in patients with septic shock. AT supplementation signi ficantly decreased the risk of death. Conclusions: Together, these studies are consistent with the positive effec t seen with AT supplementation in patients with severe sepsis. A multicente r phase III trial is currently in progress to definitively document its eff ect on mortality.