Abstract
We report an intensive care patient who was given excessive amounts of antithrombin concentrate in response to spuriously low antithrombin activity measurements and was then treated with plasmapheresis (therapeutic plasma exchange or TPE) to remove the excess.
Highlights
Antithrombin (AT) is a key physiological inhibitor of coagulation in vivo [1]
The effect of AT is increased approximately 1000-fold in the presence of heparin [3]
The chromogenic assay to measure AT activity depends on a linear relationship between the reporter signal and time
Summary
Antithrombin (AT) is a key physiological inhibitor of coagulation in vivo [1]. AT prevents the expansion and formation of clots [2]. AT inactivates thrombin, plasmin, and other serine proteases [1]. The effect of AT is increased approximately 1000-fold in the presence of heparin [3]. Recombinant or human AT is approved for the treatment and prevention of thromboembolism in those with hereditary AT deficiency [4, 5]. Human AT has an in vivo halflife of approximately 2.5-3.8 days, a molecular weight of about 58,000 kDa, and a high bioavailability in the plasma [4, 6]. There appears to be no literature on the acute removal of extremely high levels of AT
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