Recombinant human transgenic antithrombin in cardiac surgery: a dose-finding study.

This is a very important paper in two ways. First, it highlights ongoing activation of hemostasis in the postoperative period as demonstrated by the control group. The scale of Figure 1 blurs the very low activity in patients with or without a low dose of antithrombin (AT). This period of activation may even exist longer than the measured 24 hours. The postoperative period will become an important area of future research. Second, the dosage of AT to keep AT activity within a “physiologic” level is remarkably high. If AT substitution is indicated, a sufficient (huge) dosage should be employed. It is questionable whether we can reach these quantities of AT with transfusion of FFP. Whether we really need a recombinant (and therefore expensive) drug remains debatable.

– Wulf Dietrich