• J Kienast, M Juers, C J Wiedermann, J N Hoffmann, H Ostermann, R Strauss, H-O Keinecke, B L Warren, S M Opal, and KyberSept investigators.
• Department of Internal Medicine, Hematology/Oncology, Westfaelische Wilhelms University, Muenster, Germany.
• J. Thromb. Haemost. 2006 Jan 1;4(1):90-7.

BackgroundDisseminated intravascular coagulation (DIC) is a serious complication of sepsis that is associated with a high mortality.ObjectivesUsing the adapted International Society on Thrombosis and Haemostasis (ISTH) diagnostic scoring algorithm for DIC, we evaluated the treatment effects of high-dose antithrombin (AT) in patients with severe sepsis with or without DIC.Patients And MethodsFrom the phase III clinical trial in severe sepsis (KyberSept), 563 patients were identified (placebo, 277; AT, 286) who did not receive concomitant heparin and had sufficient data for DIC determination.ResultsAt baseline, 40.7% of patients (229 of 563) had DIC. DIC in the placebo-treated patients was associated with an excess risk of mortality (28-day mortality: 40.0% vs. 22.2%, P < 0.01). AT-treated patients with DIC had an absolute reduction in 28-day mortality of 14.6% compared with placebo (P = 0.02) whereas in patients without DIC no effect on 28-day mortality was seen (0.1% reduction in mortality; P = 1.0). Bleeding complications in AT-treated patients with and without DIC were higher compared with placebo (major bleeding rates: 7.0% vs. 5.2% for patients with DIC, P = 0.6; 9.8% vs. 3.1% for patients without DIC, P = 0.02).ConclusionsHigh-dose AT without concomitant heparin in septic patients with DIC may result in a significant mortality reduction. The adapted ISTH DIC score may identify patients with severe sepsis who potentially benefit from high-dose AT treatment.

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