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Purified antithrombin supplementation in coronary revascularisation operations

Published online by Cambridge University Press:  01 June 2007

M. Rossi ,
M. Ranucci ,
G. Soro ,
R. Schiavello  and
S. Guarneri
M. Rossi
Affiliation:
Catholic University of Holy Hearth, Biomedical Sciences High Technology Research Centre, Department of Anaesthesia, Intensive Care and Pain Therapy, Campobasso, Italy
M. Ranucci*
Affiliation:
IRCCS Policlinico S. Donato, Department of Cardiothoracic Anaesthesia and Intensive Care, Rome, Italy
G. Soro
Affiliation:
IRCCS Policlinico S. Donato, Department of Cardiothoracic Anaesthesia and Intensive Care, Rome, Italy
R. Schiavello
Affiliation:
Catholic University, Division of Cardiac Anaesthesia, Department of Anaesthesia and Intensive Care, Rome, Italy
S. Guarneri
Affiliation:
Catholic University, Division of Cardiac Anaesthesia, Department of Anaesthesia and Intensive Care, Rome, Italy
*
Correspondence to: Marco Ranucci, Dept of Cardiothoracic Anaesthesia and Intensive Care, Istituto Policlinico S. Donato, Via Morandi 30, 20097 San Donato Milanese (Milan) Italy. E-mail: cardioanestesia@virgilio.it; Tel: +39 02 52774546; Fax: +39 02 55602262
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Summary

Background and objective

Purified antithrombin concentrates or human recombinant antithrombin have been proposed for treating heparin resistance in cardiac operations with cardiopulmonary bypass, and exert a beneficial effect in terms of haemostatic system activation control. However, little information is available with respect to antithrombin supplementation and clinical outcome in selected categories of patients. The aim of this study is to evaluate clinical outcome data in patients intraoperatively treated with purified antithrombin compared to a control population.

Methods

89 patients forming the AT-treated group received purified antithrombin to correct preoperatively low values of antithrombin activity or to treat heparin resistance. The Control group was retrospectively created with a propensity score analysis. After verifying the homogeneity of the two groups, various outcome variables were compared between groups.

Results

Patients in the AT-treated group had a shorter Intensive Care Unit (2.6 ± 3 vs. 3 ± 2.7 days) and Hospital (7.5 ± 3.5 vs. 8.6 ± 4.5 days) stay, and a lower rate (relative risk 0.1, 95% confidence interval 0.01–0.81) of severe postoperative morbid events. Conversely, they demonstrated a significant, albeit clinically irrelevant, more pronounced postoperative bleeding tendency.

Conclusions

AT supplementation in patients at risk for inadequate thrombin suppression during the operation reduces postoperative complications and shortens the recovery time. However, a careful monitoring of the heparin requirements is recommended in order to avoid an undesired excessive postoperative bleeding.

Keywords

antithrombincardiopulmonary bypasssurgerycomplications
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue S40 , June 2007 , pp. 71 - 76
Copyright
Copyright © European Society of Anaesthesiology 2007

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