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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
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ANTITHROMBIN III IN SEVERE SEPSIS  SMART 2002 Milan, May 29-31, 2002


Minerva Anestesiologica 2002 May;68(5):454-7

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Antithrombin III. Key factor in extracorporeal circulation

Ranucci M.

From the Istituto Policlinico S. Donato Department of Cardiothoracic Anesthesia San Donato Milanese (Milan) - Italy


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Anti­throm­bin III ­plays ­many dif­fer­ent ­roles dur­ing car­diac oper­a­tions ­with car­di­o­pul­mo­nary ­bypass. Basi­cal­ly, it ­acts as the nat­u­ral inhib­i­tor of throm­bin, ­which, in pres­ence of hep­ar­in, ­blocks the throm­bin ­action and ­avoids ­gross throm­bus for­ma­tion ­inside the extra­cor­po­real cir­cu­la­tion cir­cuit. By act­ing as a “sui­cide sub­strate”, anti­throm­bin III is con­sumed dur­ing car­di­o­pul­mo­nary ­bypass; at the ­same ­time, throm­bin is exten­sive­ly ­formed dur­ing and ­after car­di­o­pul­mo­nary ­bypass. As a ­result, at the end of the oper­a­tion ­there is a poten­tial imbal­ance in the anti­throm­bin III-throm­bin inter­ac­tion, lead­ing to a pro­throm­bot­ic stat­us. More­over, ­patients pre-treat­ed ­with hep­ar­in ­reach the oper­at­ing the­a­ter ­with ­reduced lev­els of cir­cu­lat­ing anti­throm­bin III; ­this may ­lead to the hep­ar­in resis­tance phe­nom­e­non and may fur­ther ­increase the ­risk for post­op­er­a­tive throm­bot­ic com­pli­ca­tions. Final­ly, the ­anti-inflam­ma­to­ry prop­er­ties of anti­throm­bin III in the set­ting of the “­whole ­body inflam­ma­to­ry reac­tion” ­induced by the car­di­o­pul­mo­nary ­bypass rep­re­sents a new and unex­plored ­field of ­research.

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