BACKGROUND. Patients with severe hepatic failure present acquired deficiency of antithrombin III (ATIII) owing to reduced synthesis associated with intravascular activation of blood coagulation, which may be corrected by ATIII infusion. OBJECTIVE. The aim of this uncontrolled trial was to verify the effect of a standard dose of ATIII concentrate (Kybernin™ ), that is, 50U/kg of body weight per day, every 2 days, on ATIII levels in patients with severe hepatic failure and hemostatic imbalance. PATIENTS AND METHODS. Six cirrhotic patients were studied: mean age of 44 years (14 to 63 years), who presented at least 2 abnormal coagulation tests (PT > 1.40, APTT > 1.25, Fibrinogen < 1.5g/dL, Platelet count < 80,000/mm³). Mean serum albumin was 2.6g/dL (1.9 to 3.8g/dL). Blood was drawn before infusion, 4h after the first infusion, and just before the next infusion. ATIII levels were measured by amidolytic method. RESULTS. Mean ATIII levels were: initial = 35.8%, 4th h = 56.2%*, 2th d = 48.7%*, 4 d th = 45.7%*, and 8th d = 42.3%. ATIII levels increased significantly after infusion of this standard dose in all patients, although they have not been fully corrected (Friedman test, * p < 0.02), which has been sustained till the 4th day. There was no improvement on the clinical outcome. CONCLUSIONS. These findings suggest that doses of ATIII concentrate higher than 50U/kg/infusion must be administered to patients with severe hepatic failure, to guarantee normal levels of the inhibitor, in order to verify its influence on the hemostatic mechanism.
Antithrombin III; Hepatic failure; Cirrhosis; Disseminated intravascular coagulation; Acquired coagulopathies
