Continuous versus intermittent infusion of human antithrombin III concentrate in the immediate postoperative period after liver transplantation

Antithrombin--III (AT--III) concentrates have been used in the immediate postoperative period after liver transplantation to prevent critical thrombosis. We aimed to investigate a more appropriate method for AT--III concentrate administration to maintain plasma AT--III activity level within the target range. In this randomized controlled trial, 130 adult patients undergoing living--donor liver transplantation were randomized to either the intermittent group or continuous group. In the intermittent group, 500 international units (IU) of AT--III concentrate were administered after liver transplantation and repeated every 6 h for 72 h. In the continuous group, 3000 IU of AT--III were continuously infused for 71 h after a loading dose of 2000 IU over 1 h. Plasma AT--III activity level was measured at 12, 24, 48, 72, and 84 h from the first AT--III administration. The primary outcome was the target (80%--120%) attainment rate at 72 h. Target attainment rates at other timepoints and associated complications were collected as secondary outcomes. A total of 107 patients were included in the analysis. The target attainment rates at 72 h post--dose were 30% and 62% in the intermittent group and continuous group, respectively (p = 0.003). Compared to the intermittent group, patients in the continuous group reached the target level more rapidly (12 vs. 24 h, median time, p < 0.001) and were more likely to remain in the target range until 84 h. For maintaining the target plasma AT--III activity level after living-donor liver transplantation, continuous infusion of AT--III seemed to be more appropriate compared to the conventional intermittent infusion regimen.

Automated summary

This study investigated the appropriate method of antithrombin-III (AT-III) concentrate administration after liver transplantation to maintain plasma AT-III activity within the target range. The study randomized 130 adult patients into intermittent and continuous groups, and found that the continuous group had a higher rate of target attainment within 72 hours.