Higher Thrombin-Antithrombin III Complex Levels May Indicate Severe Acute Pancreatitis

Aim: Coagulation disorders may develop in association with severe acute pancreatitis (AP). Plasma thrombin-antithrombin III complex (TAT) levels are one of the principal markers of coagulation disorder. The purpose of this study was to evaluate TAT and other hemostatic parameters in patients with AP and to examine whether or not these parameters indicate the severity of AP. Method: Forty-six patients with AP (14 severe, 32 non-severe) and a 30-member healthy control group were recruited. The severity of AP was determined using the revised Atlanta classification. ELISA was used to measure patients’ plasma TAT levels. Results: The TAT levels of AP patients at presentation were higher than those of the control group (p = 0.005). The plasma TAT levels of patients with severe AP were also significantly higher than those of patients with non-severe AP (p = 0.05) and of the control group (p < 0.001). The general accuracy, sensitivity and specificity of TAT levels in predicting the severity of AP were 77.4, 77.8, and 77.3% respectively. Conclusion: The coagulation cascade was activated in the AP patients in our study, and this was shown to become more pronounced as severity of the disease increased. Plasma TAT levels at the time of presentation in patients with AP can be used as a marker for predicting the severity of the disease.

Thrombin–antithrombin III complex tests

Purpose: Patients with fractures of the pelvis and/or lower extremities are at a high risk of developing postoperative venous thromboembolism (VTE). The purpose of this study was to determine whether the thrombin–antithrombin III complex (TAT) tests could be used for postoperative screening of VTE in patients with lower limb or pelvic fractures. Methods: We enrolled 133 patients who underwent surgical treatment for fracture of the pelvis or lower extremities. TAT and D-dimer levels were compared in patients with and without VTE. Receiver operating characteristic (ROC) curve analysis was done and the appropriate TAT and D-dimer cutoff levels were determined for VTE screening. Results: VTE was diagnosed in 41 patients (30.8%). Patients with VTE had significantly higher levels of TAT and D-dimer on postoperative days 1, 3, and 7 than those without VTE, respectively. ROC curve analysis suggested that TAT test at postoperative day 7 had the highest accuracy for predicting postoperative VTE. With the optimal cutoff TAT level of 3.0 ng/mL, sensitivity and specificity were 93.3% and 70.1%, respectively. With the optimal cutoff D-dimer level of 7.4 µg/mL, sensitivity and specificity were 93.3% and 57.0%, respectively. Conclusion: TAT levels measured at postoperative day 7 could be the most useful parameter for screening postoperative VTE. TAT can be used as a screening tool for screening postoperative VTE in patients with lower limb and pelvic fractures.

Thrombin antithrombin complex and IL-18 serum levels in stroke patients

The complex picture of inflammation and coagulation alterations comes to life in acute stroke phases. Increasing evidence points to a strong interaction and extensive crosstalk between the inflammation and coagulation systems: the interest towards this relationship has increased since recent experimental research showed that the early administration of antithrombin III (ATIII) decreases the volume of ischemia in mice and might be neuroprotective, playing an antiinflammatory role. We aimed to establish the extent of the relationship among markers of inflammation (S100B and IL-18) and procoagulant and fibrinolytic markers (ATIII, thrombin-antithrombin III complex (TAT), Fibrin Degradation Products (FDP), D-dimer) in 13 comatose patients affected by focal cerebral ischemia. Plasma levels of TAT, D-dimer and FDP, IL18 and S100B were increased. IL-18 and S100B high serum levels in ischemic patients suggest an early activation of the inflammatory cascade in acute ischemic injury. The basic principles of the interaction between inflammatory and coagulation systems are revised, from the perspective that simultaneous modulation of both coagulation and inflammation, rather than specific therapies aimed at one of these systems could be more successful in stroke therapy.

Abstract 77: Effects Of Short-term Fasting On Mortality, Inflammatory And Coagulation Responses To Endotoxin-induced Shock In Rats

Obesity is a common problem in sepsis. We evaluated the effects of short-term fasting on the mortality rate, inflammatory and coagulation response in rats with endotoxin-induced shock. Male Wister rats (n=30) were used. Animals were randomly assigned to one of two groups: control group (n=15), receiving intravenous Escherichia coli endotoxin (15 mg/kg over 2 mins); fasted group (n=15), short-term fasting for 3 days before endotoxin injection. The mortality rates, hemodynamics, arterial blood gases, plasma cytokine concentrations and coagulation parameters were measured. The mortality rates at 8hrs after endotoxin injection were 75% and 7% for control and fasted groups, respectively. Hypotension and the increases of TNF-alpha and interleukin-6 concentrations were less for the fasted group than the control group. Moreover, the increase of the prothrombin-time and thrombin-antithrombin III complex were less for the fasted group than the control group. The present study showed that short-term fasting inhibited hypotension and elevations in cytokine concentrations, reducing the mortality rate of rats with endotoxin-induced shock. Moreover, short-term fasting inhibited the elevation of coagulation parameters. These findings suggest that short-term fasting may exert favorable effects during sepsis and septic shock. Survival curves for fasted and control groups

Demonstration and Operative Influence of Low Prime Volume Closed Pump

Various improvements have been made in cardiopulmonary bypass (CPB) in the past few decades. We designed a new type of CPB to reduce the secretion of systemic inflammatory markers. We used a low prime volume pump (LPVP), completely closed CPB circuit and examined coagulant factors and inflammatory cytokines. In this study, we demonstrate the efficacy of LPVP using molecular biological data. Fourteen patients were randomized prospectively into two groups: Group L patients underwent LPVP ( n = 8) and Group N patients underwent normal prime volume CPB ( n = 6). We measured thrombin-antithrombin III complex (TAT), complement factor (C3a), and interleukin (IL)-10 levels at four time points. TAT (66.1 ± 15.1 ng·mL−1), C3a (1895 ± 282 ng·mL−1) and IL-10 (486 ± 114 pg·mL−1) levels in Group N were significantly higher than in Group L (TAT, 19.5 ± 4.4 ng·mL−1; IL-10, 105 ± 24.6 pg·mL−1; C3a, 1349 ± 369 ng·mL−1) immediately following CPB. LPVP demonstrated a lower systemic inflammatory response compared to normal prime volume CPB, as assessed using a molecular biological approach.