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Anästhesiol Intensivmed Notfallmed Schmerzther 2001; 36(3): 143-153
DOI: 10.1055/s-2001-11815
ÜBERSICHT
© Georg Thieme Verlag Stuttgart · New York

Gibt es gesicherte Indikationen
für den Einsatz von Antithrombin III in der Intensivmedizin?

P. J. Kulka1 , M. Tryba2 , S. Lange3
  • 1Abteilung für Anästhesiologie und IntensivmedizinEvangelisches Krankenhaus Oberhausen
  • 2Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Klinikum Kassel gGmbH
  • 3Abteilung für Medizinische Informatik, Biometrie und Epidemiologie, Ruhr-Universität-Bochum
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Publication History

Publication Date:
31 December 2001 (online)

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Zusammenfassung.

Antithrombin III (AT III) ist ein Serinprotease-Inhibitor mit antikoagulatorischen und antiinflammatorischen Eigenschaften, der zur Therapie septischer Krankheitsbilder empfohlen wurde. Im Tierversuch ist die prophylaktische Gabe von AT III in einer Dosis von > 250 IE/kg in der Lage, die Entstehung disseminierter intravasaler Gerinnungsstörungen und Organfunktionsstörungen nach Gabe eines Endotoxins oder lebender Bakterien zu verhindern und die Mortalität zu senken. In Untersuchungen an septischen Patienten, bei denen die Substitutionstherapie erst Stunden nach Krankheitsbeginn mit deutlich geringeren Dosierungen erfolgte, konnten durch die AT III-Substitution die laborchemischen Veränderungen der DIC behandelt werden, ein Beweis für die Senkung der Mortalität steht jedoch noch aus. Auf der Basis der bis heute durchgeführten Untersuchungen ist die Substitutionstherapie mit AT III beim hereditären AT III-Mangel, bei schlechtem Ansprechen einer Heparintherapie durch niedrige AT III-Spiegel sowie bei einer manifesten disseminierten intravasalen Gerinnungsstörung indiziert. Da der Einfluss von AT III auf relevante klinische Outcomeparameter bisher nicht eindeutigt belegt werden kann, ist es u. E. jedoch nicht möglich, SIRS, Sepsis oder septischen Schock als eindeutige Indikation für den Einsatz von AT III oder die im Rahmen einer solchen Therapie erforderlichen Dosierungen festzulegen.

Are there Certified Indications for the Use of Antithrombin III in Intensive Care?

The serine-protease-inhibitor antithrombin III (AT III) has often been recommended for the therapy of septic patients as it provides anticoagulant and antiinflammatory actions. In animal studies the prophylactic treatment with AT III in a dose > 250 U/kg prevented the development of disseminated intravascular coagulopathy and vital organ dysfunction during sepsis and lowered the mortality rate. In clinical studies with septic patients therapy usually was started several hours after the start of the disease in dosages much lower than those used in animal studies. In these patients AT III-therapy improved laboratory changes of disseminated intravascular coagulopathy but was unable to lower the mortality rate. Hereditary AT III deficiency, lack of heparin effect due to low AT III levels, disseminated intravascular coagulation disorders are indications for the use of AT III while beneficial effects of AT III in patients suffering from SIRS, sepsis or septic shock have not yet been demonstrated.

Schlüsselwörter:

Antithrombin III - AT III - SIRS - Sepsis - Septischer Schock

Key words:

Antithrombin III - AT III - SIRS - Sepsis - Septic shock

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Privat-Dozent Dr. P. J. Kulka

Evangelisches Krankenhaus Oberhausen EKO
(Akademisches Lehrkrankenhaus der Universität Essen)
Abteilung für Anästhesiologie und Intensivmedizin

Virchowstraße 20

46047 Oberhausen

Email: Peter.Kulka@ruhr-uni-bochum.de

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