Thromb Haemost 2016; 115(04): 712-728
DOI: 10.1160/TH15-08-0687
Review Article
Schattauer GmbH

Antithrombin: anti-inflammatory properties and clinical applications

Jerrold H. Levy
1  Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
Roman M. Sniecinski
2  Department of Anesthesiology, Emory University, Atlanta, Georgia, USA
Ian J. Welsby
1  Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
Marcel Levi
3  Department of Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
› Author Affiliations
Financial support: This work was supported by grant IJW NIH R01HL121232–01.
Further Information

Publication History

Received: 27 August 2015

Accepted after major revision: 08 November 2015

Publication Date:
11 November 2017 (online)


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.