A Clinical Study of Antithrombin lll Therapy for Disseminated Intravascular Coagulation in Neonates

PURPOSE: The purpose of this study is to evaluate the clinical effect of antithrombin lll concentrates in disseminated intravascular coagulation (DIC) of neonates. METHODS: We reviewed the clinical records of 11 newborn patients who had been admitted and diagnosed as DIC at the neonatal intensive care unit of Sanggye Paik Hospital from November, 1995 to September, 1996. RESULTS: There were 6 males and 5 females. In 9 cases (81.8%), gestational age was less than 37 weeks and birth weight was less than 2,500g. Sepsis was the most common underlying disease in 9 cases (81.8%), followed by respiratory distress syndrome, necrotizing enterocolitis, and fulminant hepatitis. The etiologic organisms of sepsis, were gram negative organisms, fungus, and gram positive organisms in decreasing order. There were signs of gastrointestinal tract hemorrhage, pulmonary hemorrhage, and intracranial hemorrhage as a result of DIC. In the clinical outcome of DIC patients, 6 out of 11 patients survived (54.5%). CONCLUSION: Administration of antithrombin lll concentrates in DIC of neonates produces improvement of clinical course and survival.

Effects of Prolonged Major Surgery and Massive Transfusion on the Coagulation and Fibrinolysis System / 대한마취과학회지

The anesthesiologist is sometime presented with the problem of coagulation defects through the perioperative period. The possible causes of inappropriate hemostasis in this situation are numerous, and multiple mechanism may be simultaneously involved. Coagulation and fibrinolysis variables were measured in 15 patients who had undergone prolonged major surgery or received massive transfusion before and until 10 days after operation. Hemostactic surveys included platelet count, fibrinogen, prothrombin time, activated partial thromboplastin time, antithrombin lll, and fibrin degraduation products. No patients had major hemorrhage, thrombosis, or disseminated intravascular coagulation, but laboratory findings suggest that a hypercoagulable state existed even 10 days postoperatively. The results were as follows: 1) Platelet counts decreased just after operation, but significantly increased to 154% of the control value 7 days after operation and 204% 10 days postoperatively. 2) Prothrombin time was significantly prolonged just after operation compared to the control value, but returned to normal in 4 days postoperatively. 3) Fibrinogen decreased just after operation, but significantly increased to 165% of the control value 4 days after operation, 178% 7days after operation and 191% 10 days postoperatively. 4) Activated partial thromboplastin time was not changed through the entire period. 5) Antithrombin lll was not changed through the entire period. 6) Fibrin degradation product was within normal ranges before operation, but in 11 cases it exceeded normal range from 1 to 10 days postoperatively.