Avidan, M. S. and Levy, J. H. and van Aken, H. and Feneck, R. O. and Latimer, R. D. and Ott, E. and Martin, E. and Birnbaum, Dietrich E. and Bonfiglio, L. J. and Kajdasz, D. K. and Despotis, G. J. (2005) Recombinant human antithrombin III restores heparin responsiveness and decreases activation of coagulation in heparin-resistant patients during cardiopulmonary bypass. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, 130 (1). pp. 107-113. ISSN 0022-5223, 1097-685X
Full text not available from this repository. (Request a copy)Abstract
Objectives: We sought to evaluate the efficacy of recombinant human antithrombin III for restoration of heparin responsiveness in heparin-resistant patients scheduled for cardiac surgery. Methods: This was a multicenter, randomized, double-blind, placebo-controlled study in heparin-resistant patients undergoing elective cardiac surgery. Patients were considered heparin resistant if the activated clotting time was less than 480 seconds after 400 U/kg heparin. Fifty-two heparin-resistant patients were randomized into 2 cohorts. One cohort received a single bolus (75 U/kg) of recombinant human antithrombin III (n = 28), and the other, the placebo group (n = 24), received a normal saline bolus. If the activated clotting time remained less than 480 seconds, this was defined as treatment failure, and 2 units of fresh frozen plasma were transfused. Patients were monitored for adverse events during hospitalization. Results: Six (21%) of the patients in the recombinant human antithrombin III group received fresh frozen plasma transfusions compared with 22 (92%) of the placebo-treated patients (P < .001). Two units of fresh frozen plasma did not restore heparin responsiveness. There was no increased incidence of adverse events associated with recombinant human antithrombin III administration. Postoperative 24-hour chest tube bleeding was not different in the 2 groups. Surrogate measures of hemostatic activation suggested that there was less activation of the hemostatic system during cardiopulmonary bypass in the recombinant human antithrombin III group. Conclusion: Treatment with recombinant human antithrombin III in a dose of 75 U/kg is effective in restoring heparin responsiveness and promoting therapeutic anticoagulation for cardiopulmonary bypass in the majority of heparin-resistant patients. Two units of fresh frozen plasma were insufficient to restore heparin responsiveness. There was no apparent increase in bleeding associated with recombinant human antithrombin III.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FRESH-FROZEN PLASMA; CARDIAC-SURGERY; CLOTTING TIME; DOUBLE-BLIND; ANTICOAGULATION; OPERATIONS; THROMBOSIS; THERAPY; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Anästhesiologie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 07 May 2021 11:55 |
| Last Modified: | 07 May 2021 11:55 |
| URI: | https://pred.uni-regensburg.de/id/eprint/35952 |
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