Antithrombin III concentrate in the acute phase of thermal injury

Background: Thermal injury disrupts homeostasis by inducing subclinical disseminated intravascular coagulation, fibrinolysis, and an acquired deficiency of Antithrombin III (ATIII), a natural anticoagulant. As a result, thermally injured patients have a high incidence of hypercoagulability and thrombosis. Objective: ATIII (Human) concentrate was given to a thermally injured patient to evaluate safety, and dosage requirements in this setting. Design: The patient was a 40 yr old male with a 68% total burn surface area, right femoral comminuted fracture, and C5–C6 subluxation sustained in a vehicular crash. He received nine infusions of AT III (H) concentrate (100–50 u/kg) within the first four days of injury. Result: The ATIII plasma level increased from 45% on admission (normal=100±20%) to 120±25% in the next four days. During the 64 day hospitalization, there were 11 grafting procedures with an estimated blood loss (EBL)/procedure: 1140 cc; and EBL/grafted surface area ratio: 0.6 cc/cm2. The average time to healing of the meshed autograft was 6.4 days. Conclusion: ATIII (H) concentrate can be safely utilized in the acute phase of thermal injury: no excessive bleeding or prolongation of wound healing was documented..