+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Antithrombin III in critically ill patients: systematic review with meta-analysis and trial sequential analysis



Antithrombin III in critically ill patients: systematic review with meta-analysis and trial sequential analysis



Bmj 335(7632): 1248-1251



To evaluate the benefits and harms of antithrombin III in critically ill patients. Systematic review and meta-analysis of randomised trials. CENTRAL, Medline, Embase, International Web of Science, LILACS, the Chinese Biomedical Literature Database, and CINHAL (to November 2006); hand search of reference lists, contact with authors and experts, and search of registers of ongoing trials. Two reviewers independently selected parallel group randomised clinical trials comparing antithrombin with placebo or no intervention and extracted data related to study methods, interventions, outcomes, bias risk, and adverse events. Disagreements were resolved by discussion. Trials in any type of critically ill patients in intensive care were eligible. All trials, irrespective of blinding or language status, that compared any antithrombin III regimen with no intervention or placebo were included. Trials were considered to be at low risk of bias if they had adequate randomisation procedure, blinding, and used intention to treat analysis. Risk ratios with 95% confidence intervals were estimated with fixed and random effects models according to heterogeneity. Mortality, length of stay in intensive care or hospital, quality of life, severity of sepsis, respiratory failure, duration of mechanical ventilation, incidence of surgical intervention, intervention effect among various populations, and adverse events (such as bleeding). 20 trials randomly assigning 3458 patients met inclusion criteria. Eight trials had low risk of bias. Compared with placebo or no intervention, antithrombin III did not reduce overall mortality (relative risk 0.96, 95% confidence interval 0.89 to 1.03). No subgroup analyses on risk of bias, populations of patients, or with and without adjuvant heparin yielded significant results. Antithrombin III increased the risk of bleeding events (1.52, 1.30 to 1.78). Heterogeneity was observed in only a few analyses. Antithrombin III cannot be recommended for critically ill patients based on the available evidence.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 020656307

Download citation: RISBibTeXText

PMID: 18037615

DOI: 10.1136/bmj.39398.682500.25


Related references

Antithrombin III for critically ill patients: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Medicine 42(4): 505-520, 2016

Dopamine in critically ill patients with cardiac dysfunction: A systematic review with meta-analysis and trial sequential analysis. Acta Anaesthesiologica Scandinavica 63(4): 424-437, 2019

Randomised trials of vitamin D 3 for critically ill patients in adults: systematic review and meta-analysis with trial sequential analysis. Intensive Care Medicine 43(2): 277-278, 2017

Effects of levosimendan for low cardiac output syndrome in critically ill patients: systematic review with meta-analysis and trial sequential analysis. Intensive Care Medicine 41(2): 203-221, 2015

Balanced crystalloids versus normal saline for fluid resuscitation in critically ill patients: A systematic review and meta-analysis with trial sequential analysis. American Journal of Emergency Medicine 2019:, 2019

Milrinone for cardiac dysfunction in critically ill adult patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Medicine 42(9): 1322-1335, 2016

Polymyxin B-immobilized hemoperfusion and mortality in critically ill adult patients with sepsis/septic shock: a systematic review with meta-analysis and trial sequential analysis. Intensive Care Medicine 44(2): 167-178, 2018

Nebulised dornase alfa versus placebo or hypertonic saline in adult critically ill patients: a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Systematic Reviews 4: 153, 2015

The effects of high-flow nasal cannula on intubation and re-intubation in critically ill patients: a systematic review, meta-analysis and trial sequential analysis. Revista Brasileira de Terapia Intensiva 30(4): 487-495, 2019

Stress ulcer prophylaxis versus placebo or no prophylaxis in critically ill patients. A systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Intensive Care Medicine 40(1): 11-22, 2014

Restrictive versus liberal transfusion strategy for red blood cell transfusion in critically ill patients and in patients with acute coronary syndrome: a systematic review, meta-analysis and trial sequential analysis. Minerva Anestesiologica 82(5): 582-598, 2016

Prothrombin complex concentrate versus placebo, no intervention, or other interventions in critically bleeding patients associated with oral anticoagulant administration: a protocol for a systematic review of randomised clinical trials with meta-analysis and trial sequential analysis. Systematic Reviews 7(1): 169, 2018

Safety and efficacy of iron therapy on reducing red blood cell transfusion requirements and treating anaemia in critically ill adults: A systematic review with meta-analysis and trial sequential analysis. Journal of Critical Care 49: 162-171, 2019

Exercise for patients with major depression: a systematic review with meta-analysis and trial sequential analysis. Bmj Open 7(9): E014820, 2017

Exercise for patients with major depression: a protocol for a systematic review with meta-analysis and trial sequential analysis. Systematic Reviews 4: 40, 2015