Summary
Many humoral and cellular components participate in bidirectional communication between
the coagulation and inflammation pathways. Natural anticoagulant proteins, including
antithrombin (AT), tissue factor pathway inhibitor, and protein C, suppress proinflammatory
mediators. Conversely, inflammation blunts anticoagulant activity and, when uncontrolled,
promotes systemic inflammation-induced coagulation, such as those that occur in disseminated
intravascular coagulation and severe sepsis. This review discusses the mechanisms
of action and clinical use of AT concentrate in critically ill patients and in the
settings of perioperative anticoagulation management for surgery and obstetrics. AT
is a serine protease inhibitor with broad anticoagulant activity and potent anti-inflammatory
properties. In clinical conditions associated with hereditary or acquired AT deficiency,
administration of AT concentrate has been shown to restore proper haemostasis and
attenuate inflammation. Of note, AT modulates inflammatory responses not only by inhibiting
thrombin and other clotting factors that induce cytokine activity and leukocyte-endothelial
cell interaction, but also by coagulation-independent effects, including direct interaction
with cellular mediators of inflammation. An increasing body of evidence suggests that
AT concentrate may be a potential therapeutic agent in certain clinical settings associated
with inflammation. In addition to the well-known anticoagulation properties of AT
for the treatment of hereditary AT deficiency, AT also possesses noteworthy anti-inflammatory
properties that could be valuable in treating acquired AT deficiency, which often
result in thrombotic states associated with an inflammatory component.
Keywords
Antithrombin - cardiac surgery - coagulation - disseminated intravascular coagulation
- inflammation - pregnancy
