Therapy with high-doses of antithrombin III in patients with septic shock and agranulocytosis

• Published in: Anesteziologiia i reanimatologiia Vol. 59; no. 4; p. 39
• Main Authors: Galstian, G M, Krechetova, A V, Troitskaia, V V, Makarova, P M, Shutova, N A, Gemdzhian, É G, Orel, E B, Kesel'man, S A, Savchenko, V G
• Format: Journal Article
• Language: Russian
• Published: Russia (Federation) 01-07-2014
• Subjects: Adolescent; Adult; Aged; Agranulocytosis - blood; Agranulocytosis - drug therapy; Agranulocytosis - etiology; Antithrombin III - administration & dosage; Antithrombin III - adverse effects; Antithrombin III - therapeutic use; Antithrombins - administration & dosage; Antithrombins - adverse effects; Antithrombins - therapeutic use; APACHE; Disease-Free Survival; Dose-Response Relationship, Drug; Female; Hematologic Diseases - complications; Hematologic Diseases - drug therapy; Humans; Male; Middle Aged; Shock, Septic - blood; Shock, Septic - drug therapy; Shock, Septic - etiology; Treatment Outcome; Young Adult
• ISSN: 0201-7563

The aim of the study was to assess efficacy of high-doses ofantithrombin 111 (AT) for treatment of septic shock in patients with an agranulocytosis.
Prospective, controlled study.
29 patients from 18 to 74 years old, with blood diseases complicated with septic shock Dates of study: from 2006 to 2012.
The patients were randomized into two groups. Group-1 included 14 patients, who did not receive AT and group-2 included 15 patients who received AT.
Demographic indicators, condition severity according to APACHE II, level of thrombocytopenia, levels ofplasma procalcitonin, interleukin-6 (IL-6) and C-reactive protein (CRP) were the same in both groups. Level of AT was decreased in both groups; however it was higher in the group-1 (50% vs. 60%, p < 0.05). In the group-1, microorganisms were found in the blood of 9 patients. In the group-2, the microorganisms were found in the blood of 11 patients. Inflammation markers were decreased after the treatment of septic shock in both groups (p<0.05). The decreasing of procalcitonin in group-1 was from 43.8 to 1 ng/ml in 14 days and from 12.8 to 1.6 ng/ml in 7 days in group-2. The decreasing of CRP in group-1 was from 224 to 114 mg/l in 7 days and from 146 to 60 mg/l in 14 days in group-2. The decreasing of IL-6 in group-1 was from 1617 to 100 pg/ml in 3 days and from 5895 to 77 pg/ml in 7 days in group-2. A level of AT was increased only in group-2 (under 12% per day). 28-day survival was higher in group-2 (60 +/- 13% vs. 45 +/- 13%, p<0.05). We did not find any complications of the treatment with AT concentrate.
Treatment of septic shock with high-doses of antithrombin III was effective and safe in patients with an agranulocytosis.