>>My interpretation is that this slight “evidence” of efficacy when AT was used without heparin was probably an artifact and that AT does not work in sepsis, period.<<
A P value of 0.03 is weak, but significant. It's worth considering that the phenomenon may be real, IMHO.
Increased bleeding? No such interaction was observed when heparin was co-administered with activated protein C (both rAPC and antithrombin III down-regulate the coagulation cascade, albeit by different mechanisms).
BTW, the editorial I sited states: "While major bleeding complications were significantly more common in patients receiving concomitant heparin (Table 4 of Warren et al), the RR of 1.77 in treated patients is not substantially different from the RR of major bleeding of 1.71 for treated patients who did not receive heparin, and the statistical significance of the findings in the former subgroup can be readily explained on the basis of the larger sample size." Perhaps the high dose of antithrombin used in this study simply increases the risk of bleeding complications irrespective of heparin use?
As for heparin and burns, it would appear that it is used routinely by some in an effort to prevent deep vein thrombosis, although this use may be controversial.
Dew, I'm not attacking ATryn, by the way. I'm just entertaining arguments against its uses in aquired AT deficiencies, uses suggested by GTCB management. I wouldn't bother if I didn't consider GTCB an attractive potential investment. Perhaps I am nit-picking? The platform is attractive, the valuation is very low (probably because the technology is both novel and controversial), and safety is likely to be superior to human plasma-derived proteins.
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