Antithrombin for severe sepsis? Try it again, but without heparin!

• References

• 1 Kaneider NC, Forster E, Mosheimer B. et al. Syndecan-4-dependent signaling in the inhibition of endotoxin-induced endothelial adherence of neutrophils by antithrombin. Thromb Haemost 2003; 90: 1150-7.
• 2 Leitner JM, Firbas C, Mayr FB. et al. Recombinant human antithrombin inhibits thrombin formation and interleukin6 release in human endotoxemia. Clin Pharmacol Ther 2006; 79: 23-34.
• 3 Oelschlager C, Römisch J, Staubitz A. et al. Antithrombin III inhibits nuclear factor kappaB activation in human monocytes and vascular endothelial cells. Blood 2002; 99: 4015-20.
• 4 Hoffmann JN, Vollmar B, Laschke MW. et al. Adverse effect of heparin on antithrombin action during endotoxemia: microhemodynamic and cellular mechanisms. Thromb Haemost 2002; 88: 242-52.
• 5 Pulletz S, Lehmann C, Volk T. et al. Influence of heparin and hirudin on endothelial binding of antithrombin in experimental thrombinemia. Crit Care Med 2000; 28: 2881-6.
• 6 Opal SM, Kessler CM, Roemisch J, Knaub S. Antithrombin, heparin, and heparan sulfate. Crit Care Med 2002; 30: 325-31.
• 7 Hoffmann JN, Wiedermann CJ, Juers M. et al. Benefit/risk profile of high dose antithrombin in patients with severe sepsis treated with and without concomitant heparin. Thromb Haemost 2006; 95: 850-6.
• 8 Wiedermann CJ, Hoffmann JN, Juers M. et al. High-dose antithrombin III in the treatment of severe sepsis in patients witha high risk of death: efficacy and safety. Crit Care Med 2006; 34: 285-92.
• 9 Spiel AO, Firbas C, Mayr FB. et al. The effects of supra-normal protein C levels on markers of coagulation, fibrinolysis and inflammation in a human model of endotoxemia. Thromb Haemost 2005; 94: 1148-55.
• 10 Derhaschnig U, Reiter R, Knobl P. et al. Recombinant human activated proteinC (rhAPC; drotrecogin alfa [activated]) has minimal effect on markers of coagulation, fibrinolysis, and inflammation in acute human endotoxemia. Blood 2003; 102: 2093-8.