Authors
Khamitov R.G., Shestakov E.A., Moskovtseva T.K., Nikolaev I.S., Branko V.V., Yudina O.V., Dementienko M.V., Fedyk O.V., Zhiburt E.B.
Pirogov National Medical and Surgical Center, Moscow
Abstract
Rationale. Antithrombin III (AT) is one of the most important natural inhibitors of blood coagulation. Antithrombin deficiency is usually detected when a patient has recurrent venous thrombosis and pulmonary embolism. Antithrombin activity is significantly enhanced in the presence of heparin, and the anticoagulant effect of heparin depends on the presence of antithrombin.
Objective: to identify patterns of AT infusions in a multidisciplinary hospital, to assess the compliance of AT use with medical care standards.
Methods. Retrospectively, based on the materials of 44,221 electronic medical records, the determination of plasma levels and the administration of AT to patients of the Pirogov Center hospital in 2024 were studied. The data were analyzed using descriptive statistics at a significance level of 0.05.
Results. Of the 44,221 patients of the hospital, the AT concentration was determined in 48 people (in 1 – twice) (0.1%): 26 women and 22 men aged 51.8 ± 14.2 (hereinafter: mean ± standard deviation) years, from 23 to 85 years.
AT level – 98.1 ± 21.1% (from 43 to 125%).
Fatal outcome – 1 (in a patient with an AT level of 43%).
37 antithrombin activity results were within normal limits. 8 – unavailable, usually due to testing on the eve of hospital discharge. 5 results – below normal.
In 2024, AT was administered to 2 patients.
Patient V., 34 years old. Pancreatic necrosis, sepsis. Treatment period is 54 days. On the 3rd day of hospitalization, the AT level was 61%. 4 vials of the drug were administered (1 vial per day). The AT level increased to 80%. 50 doses of red blood cells and 3 doses of plasma were transfused.
Patient M., 79 years old. Ischemic stroke, sepsis. Treatment period is 22 days. 1 vial of the drug was administered. No blood was transfused.
Both patients were discharged with improvement.
10 patients (21%) received blood transfusion therapy:
Conclusion. Both the determination of activity and the order of antithrombin infusion:
– are absent from the standards of medical care,
– are prescribed by individual doctors to search for the causes of possible thrombophilia and antithrombotic therapy, respectively.
The level of antithrombin in the group of blood recipients was 81.6±19.9%, which is significantly lower than in the group of non-recipients of blood was 105.8±5.7% (t-criterion 3.501, p = 0.001).
Keywords: antithrombin III, infusion, dosage, concentration, standard, evidence-based medicine.
References
1. Shevchenko YL, Karpov OE, Zhiburt EB. Blood transfusion: history and modernity (on the 100th anniversary of blood transfusion in Russia). Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2019; 14(4): 4-11. (In Russ.) doi: 10.25881/ BPNMSC.2020.29.78.001.
2. Pokhabov DS, Shestakov EA, Gusarov VG. et al. Scientific rationale for improving the clinical use of albumin in a multidisciplinary clinic. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2024; 19(4): 68-73. (In Russ.) doi: 10.25881/20728255_2024_19_4_68.
3. Pokhabov DS, Shestakov EA, Melnichenko VY, et al. Scientific rationale for the use of immunoglobulin in a multidisciplinary clinic. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2025; 20(2): 57-60. (In Russ.) doi: 10.25881/ 20728255_2025_20_2_57
4. Zhiburt EB, Khamitov RG, Pokhabov DS et al. New in transfusiology (at the congress of the International Society of Blood Transfusion in Barcelona). Gematologiya. Transfusiologiya. Vostochnaya Evropa. 2024; 10(4): 581-596. (In Russ.) doi: 10.34883/PI. 2024.10.4.008.
5. Zhiburt EB. Pirogov center blood service: yesterday, today, tomorrow. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2006; 1(1): 55-57. (In Russ.)
6. Van Cott EM, Orlando C, Moore GW, et al. Subcommittee on Plasma Coagulation Inhibitors. Recommendations for clinical laboratory testing for antithrombin deficiency; Communication from the SSC of the ISTH. J Thromb Haemost. 2020; 18(1): 17-22. doi: 10.1111/jth.14648. PMID: 31894660.
7. Wiedermann CJ. Antithrombin as Therapeutic Intervention against Sepsis-Induced Coagulopathy and Disseminated Intravascular Coagulation: Lessons Learned from COVID-19-Associated Coagulopathy. Int J Mol Sci. 2022; 23(20): 12474. doi: 10.3390/ijms232012474.
8. Zhiburt EB, Protopopova EB, Gubanova MN, et al. Circulatory overload – a “new” complication of blood transfusion. Transfuziologiya. 2016; 17(3): 76-89. (In Russ.)
9. Chemodanov IG, Gorelikova LG, Lyaskovsky AI, et al. A tool for preventing transfusion circulatory overload. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2018; 13(4): 93-95. (In Russ.)
10. Zhiburt EB, Shestakov EA, Likhonin DA, Karavaev AV. Transfusion of female plasma damages the recipient’s lungs Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2011; 6(2): 109-111. (In Russ.)
11. Shikhmirzaev TA, Chemodanov IG, Shestakov EA, et al. Pharmacoprophylaxis of transfusion reactions. Vestnik Nacional’nogo mediko-hirurgicheskogo centra im. N.I. Pirogova. 2018; 13(2): 95-99. (In Russ.)
12. Rodgers GM, Mahajerin A. Antithrombin Therapy: Current State and Future Outlook. Clin Appl Thromb Hemost. 2023; 29: 10760296231205279. doi: 10.1177/10760296231205279.
