摘要
Antithrombin(AT) is a natural anticoagulant with antiinflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT maydecrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT(ph AT) and recombinant AT(rh AT). Major ovine studies in burn and smoke inhalation injury have utilized rh AT. There have been no studies which have either translated the basic rh AT research in burn trauma, or determined the tolerance and pharmacokinetics of rh AT concentrate infusions in burn patients. Advantages of rh AT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing ph AT. Recent Japanese clinical trials have started using ph AT in abdominal sepsis successfully. This review examines the properties of both ph AT and rh AT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma.
Antithrombin(AT) is a natural anticoagulant with antiinflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT maydecrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions. Two main forms of AT are either plasma-derived AT(ph AT) and recombinant AT(rh AT). Major ovine studies in burn and smoke inhalation injury have utilized rh AT. There have been no studies which have either translated the basic rh AT research in burn trauma, or determined the tolerance and pharmacokinetics of rh AT concentrate infusions in burn patients. Advantages of rh AT infusions are no risk of blood borne diseases and lower cost. However, the majority of human burn patient studies have been conducted utilizing ph AT. Recent Japanese clinical trials have started using ph AT in abdominal sepsis successfully. This review examines the properties of both ph AT and rh AT, and analyzes studies in which they have been utilized. We believe that it is time to embark on a randomized placebo-controlled multi-center trial to establish the role of AT in both civilian and military patients with burn trauma.
