Antithrombin and hypercoagulability in sepsis: insights from thrombelastography?

Antithrombin (AT) has been used for over 25 years to successfully
treat disseminated intravascular coagulation (DIC). A four-day AT
therapy in patients with DIC in the KyberSept trial has been
related to a clear survival benefit in patients not receiving
concomitant heparin. Gonano and coworkers performed
thrombelastography (TEG) measurements in patients with severe
sepsis and clearly showed hypercoagulability, as defined by five
TEG parameters, compared to healthy controls. In the AT group they
found a trend towards normalization of TEG parameters after
treatment, although this did not reach statistical significance.
This first clinical evaluation of hypercoagulability during AT
treatment could not provide evidence for an attenuation of
coagulopathy, an effect that might be due to high inter-individual
variability.