"Heparin is a polysaccaride (sugar based) and decreases the over efficiency of AT3 by effecting the glycolisation...The serendipitous recognition of this signifant subset [group receiving ATIII in the absence of heparin in kybersept] is a compelling arguement for the effectiveness of Atryn without Heparin for the treatment of DIC"
The data is fairly compelling that heparin antagonizes the antiinflammatory effects of ATIII (and DIC has an inflammatory component). However, the two seem to be additive when it comes to bleeding
for me the 3 most compelling reasons for thinking gtcb/leo will get positive data despite the failure of kybersept are the following, probably in this order:
1. avoiding excessive bleeding by avoiding concomitant heparin therapy (ATII had more bleeding compared w placebo, but most cases, particularly severe to catastrophic type bleeds like intracranial hemorrhages, occurred in patients cotreated with the two)
2. limiting inclusion criteria to those with intermediate prognosis (i.e. recongizing that those with less severe disease and limited organ dysfunction will survive regardless, and those with the most severe cases will die regardless of treatment stratification)
3. avoiding the antagonistic effect of heparin on ATIII's antiinflammatory activity
