Antithrombin III and local serum application: adjuvant therapy in peritonitis.

Abstract

BACKGROUND:

Patients with diffuse peritonitis show an overall mortality of about 20%, probably caused by the breakdown of local defence mechanisms combined with a systemic outspread of bacteria and toxins, which often results in sepsis syndrome.

DESIGN:

In a prospective, randomized, controlled study 50 patients with diffuse secondary peritonitis were included. Patients in the therapy group were treated with an adjuvant medication consisting of a continuous intravenous infusion of antithrombin III and two intraperitoneal instillations of fresh frozen human donor serum. The aim of the study was the reduction of mortality and incidence of multiple organ failure.

RESULTS:

Mean antithrombin III plasma levels in the therapy group were raised above 140% for 4 days and were significantly higher than in the control group. With the intraperitoneal application of fresh frozen serum and antithrombin III opsonic capacity as well as thrombin, inhibitory activity in the exudate could be significantly elevated over 2 days. The 90-day-mortality rate was 6/26 (23%) in the control group and 6/24 (25%) in the therapy group. Although no improvement of mortality was achieved, a slight but not significant reduction of the severity of the multiple organ failure was seen.

CONCLUSIONS:

The chosen therapeutic approach was feasible and showed no side-effects. Yet, neither mortality nor multiple organ failure were significantly improved by the applied short-term adjuvant therapy. Thus, for future trials in severely-ill patients a longer treatment period and/or combinations of antithrombin III with other anti-inflammatory agents should be considered.

• Authors: M Schorr, M Siebeck, N Zügel, K Welcker, C Gippner-Steppert, E Czwienzek, M Gröschler, M Jochum
• Journal: European journal of clinical investigation (Eur J Clin Invest) Vol. 30 Issue 4 Pg. 359-66 (Apr 2000) ISSN: 0014-2972 [Print] England
• PMID: 10759886 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Antithrombin III

Topics

• APACHE
• Adult
• Antithrombin III (administration & dosage, therapeutic use)
• Blood Component Transfusion
• Critical Care
• Female
• Humans
• Infusions, Intravenous
• Male
• Peritonitis (etiology, mortality, therapy)
• Prospective Studies