Gårdlund Bengt
Infektionskliniken, Karolinska sjukhuset, Stockholm.
Lakartidningen. 2002 Mar 27;99(13):1456-7, 1460.
Antithrombin has been used for over two decades as adjuvant therapy in severe sepsis, especially when associated with coagulopathy. A positive effect has been demonstrated in several experimental sepsis models and a number of small clinical trials have suggested a beneficial effect. A large confirmatory randomized clinical trial with 2,314 evaluable patients with severe sepsis was recently completed [1]. No treatment effect of antithrombin was demonstrated (28 day overall mortality was 38.9% and 38.7% in the treatment and placebo groups, respectively). Among various secondary effect and subgroup analyses, it is noteworthy that no trend indicating a beneficial effect of antithrombin substitution was found even in the subgroup of patients with plasma levels of antithrombin < 60% on randomization (n = 1,117). In summary, there is presently no support for the general use of antithrombin as adjuvant therapy in severe sepsis/septic shock.
二十多年来，抗凝血酶一直被用作严重脓毒症的辅助治疗药物，尤其是在伴有凝血病时。在多个实验性脓毒症模型中已证实其具有积极作用，并且一些小型临床试验也表明了其有益效果。最近完成了一项针对2314例可评估的严重脓毒症患者的大型验证性随机临床试验[1]。结果显示抗凝血酶并无治疗效果（治疗组和安慰剂组的28天总死亡率分别为38.9%和38.7%）。在各种次要效应和亚组分析中，值得注意的是，即使在随机分组时抗凝血酶血浆水平<60%的患者亚组中（n = 1117），也未发现表明抗凝血酶替代有益的趋势。总之，目前不支持将抗凝血酶普遍用作严重脓毒症/脓毒性休克的辅助治疗。
