IS THERE A NEED FOR ANTITHROMBIN-III SUBSTITUTION EARLY AFTER BURN INJURY

The changes in antithrombin III (AT-III) levels in the blood and resti tution in coagulation parameters between patients receiving and not re ceiving AT-III substitution were examined early after burn injury. The study was divided into two parts with a total of 14 consecutive patie nts (per cent total body surface area (TBSA) greater than or equal to 20 per cent). The first six patients were given AT-III substitution wh en AT-III levels fell below 50 per cent. The second part examined the restitution of the coagulation parameters when the patients (n=8) obta ined AT-III substitution only at extremely low values of AT-III. The d ecline in AT-III observed occurred in parallel to the permeability cha nges and the haemodilution normally seen secondarily to the initial fl uid rescucitation. The observed changes in the coagulation parameters were modest and no hepatic dysfunction was noted. In addition, no diff erences of the restitution in these coagulation parameters were noted between the substituted and non-substituted groups. These results sugg est that changes in AT-III early after burn injury depend mainly on fa ctors other than an ongoing disseminated coagulation process. Probable causes are increased capillary leak and haemodilution. Our results su ggest that substitution of AT-III in the early postburn period, on the assumption that low levels alone indicate ongoing coagulation, is not warranted. (C) 1997 Elsevier Science Ltd for ISBI.