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[Antithrombin III substitution in patients in shock].

In a trial involving 61 patients suffering from shock and DIC, the relations between the concentration of heparin, the effect of heparin on coagulation and the activity of AT III were studied. The effect of heparin decreased to one-half when the activity of AT III was 75 per cent of the average normal level. At 50 per cent AT III, the effect of heparin was negligible. When AT III was substituted the disappearance rate of the AT III activity from circulation was considerably increased in the case of acute DIC, while the concentration of AT III when measured immunologically, did not show an increased disappearance. This difference suggests increased consumption of AT III by active serine proteases of coagulation. In patients substituted with AT III, the duration of acute DIC was between 16 h and 19 h, while it was 3.3 days in patients who received heparin. The survival rate of most severe cases of DIC showed a distinct trend towards improvement, but significance was lacking, probably due to the small number of comparable cases. When AT III and heparin were given simultaneously, there was no further shortening of the duration of DIC; however, severe bleeding complications occurred in some cases. The substitution of AT III was calculated on the following basis: In acute DIC an increase in AT III activity of 1 per cent can be expected when 1 unit/kg body weight is given. The same dose of AT III increases the plasma level by 1.8 per cent when the clotting system is unaffected.