Four-day antithrombin therapy does not seem to attenuate hypercoagulability in patients suffering from sepsis

INTRODUCTION: Sepsis activates the coagulation system and frequently causes hypercoagulability, which is not detected by routine coagulation tests. A reliable method to evaluate hypercoagulability is thromboelastography (TEG), but this has not so far been used to investigate sepsis-induced hypercoagulability. Antithrombin (AT) in plasma of septic patients is decreased, and administration of AT may therefore reduce the acquired hypercoagulability. Not clear, however, is to what extent supraphysiologic plasma levels of AT decrease the acute hypercoagulability in septic patients. The present study investigates the coagulation profile of septic patients before and during four day high-dose AT therapy. METHODS: Patients with severe sepsis were randomly assigned to receive either 6,000 IU AT as a bolus infusion followed by a maintenance dose of 250 IU/hour over four days (n = 17) or placebo (n = 16). TEG, platelet count, plasma fibrinogen levels, prothrombin time and activated partial thromboplastin time were assessed at baseline and daily during AT therapy. RESULTS: TEG showed a hypercoagulability in both groups at baseline, which was neither reversed by bolus or by maintenance doses of AT. The hypercoagulability was mainly caused by increased plasma fibrinogen, and to a lesser extent by platelets. Plasmatic coagulation as assessed by the prothrombin time and activated partial thromboplastin time was similar in both groups, and did not change during the study period. CONCLUSION: The current study shows a distinct hypercoagulability in patients suffering from severe sepsis, which was not reversed by high-dose AT treatment over four days. This finding supports recent data showing that modulation of coagulatory activation in septic patients by AT does not occur before one week of therapy. Trial registration: Current Control Trials ISRCTN2293102

Estimating Heat Stress Effects on the Sustainability of Traditional Freshwater Pond Fishery Systems under Climate Change

Freshwater fish production is significantly correlated with water temperature, which is expected to increase under climate change. This study evaluated changes in water temperature and their impact on productive ponds at fisheries in the Czech Republic. A model was developed to calculate surface water temperature based on the five-day mean of the air temperature and was then tested in several ponds in three major Czech fish production areas. The output of the surface water temperature model was compared with independently measured data (r = 0.79–0.96), and the verified model was then applied to predict climate change conditions. The results were evaluated with regard to the thresholds characterizing the water temperature requirements of fish species and indicated that the limitation of Czech fish farming results from (i) an increased number of continuous periods during which given fish species are threatened by high water temperatures and (ii) the extension of continuous periods with stressful water temperatures. For Czech fisheries, the model suggests a sharp increase in unprecedented temperature regimes, which will pose critical challenges to traditional forms of common carp farming within several decades. Although reducing the level of eutrophication and loading them with organic substances might alleviate expected threads, farming current fish species in deeper and colder ponds at higher elevations might be inevitable