Use of antithrombin concentrates in DIC

Antithrombin is a natural potent inhibitor of thrombin and serin proteases. Its activity decreases constantly during DIC, due to a lowered liver synthesis and higher consumption. Despite positive experimental results, controlled clinical trials could not document its effect on mortality, but a biological interaction with heparin therapy could have biaised the results. Specific controlled trials of AT in DIC are also lacking, documenting its effect on the restoration of the hemostatic balance. Despite these limitations, a reasonable use of AT supplementation can be proposed, based on this objective. Practically, the supplementation should be reserved to a clinical and biological situation of documented non hemorrhagic DIC and severe AT deficiency, without heparin association, and taking into account under close biological monitoring, the pharmacokinetic properties of the inhibitor.