Abstract
This is an interesting study showing a dramatic decrease in the initial heparin dose requirement as well as in heparin requirements during CPB in patients pretreated with ATIII after subcutaneous heparinization. I am much less impressed with reduction of blood loss shown in this study (average of 184 mL over 24 hours). The small number of patients enrolled in this study makes it impossible to evaluate any clinically relevant benefit of ATIII treatment to these patients. Considering the cost of ATIII and concerns about unanswered questions (use of ATIII in cardiac surgical patients not on heparin, use after prolonged IV heparinization, comparison with antifibrinolytics with respect to bleeding), I would wait for large clinical dose finding studies and outcome trials before recommending routine use of ATIII in cardiac patients.
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