Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Warren and colleagues1 reported that antithrombin III (AT) did not improve
clinical outcomes in patients with severe sepsis or septic shock. These results
are surprising in light of evidence of a procoagulant state during severe
sepsis, which can be favorably affected by activated protein C (APC).2 Without a full understanding of the mechanisms
of APC and AT activity, we are left with the empirical finding that a 4-day
treatment of APC is helpful while 4 days of AT is not.
Langer M, Riccardi F, Piovella F, Klersy C. Use of Anticoagulants in Patients With Sepsis. JAMA. 2002;287(4):448-449. doi:10.1001/jama.287.4.447