Recombinant human soluble thrombomodulin administration improves sepsis-induced disseminated intravascular coagulation and mortality: a retrospective cohort study

Thrombosis Journal

Takashi Nakagawa³  Katsuhiko Matsuura⁴  Takaaki Hasegawa⁴  Mao Hagihara¹  Miki Kato⁴  Takamasa Sakai²  Takahiro Kato⁴ 

[1] Department of Infection Control and Prevention, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;Laboratory of Drug Information, Meijo University Faculty of Pharmacy, 150 Yagotoyama, Tempaku-ku, Nagoya, Aichi 468-0077, Japan;Department of Emergency and Critical Care Medicine, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan;Department of Pharmacy, Aichi Medical University, 1-1 Yazakokarimata, Nagakute, Aichi 480-1195, Japan

关键词: JAAM;    DIC score;    Multiple organ failure;    Anticoagulant;    Critically ill patient;    Intensive care unit;    Thrombomodulin;    Sepsis;    Disseminated intravascular coagulation;   

Others  :  838679
DOI  :  10.1186/1477-9560-11-3

 received in 2012-11-01, accepted in 2013-02-16,  发布年份 2013

【 摘 要 】

Background

Early treatment of disseminated intravascular coagulation (DIC) can be associated with improved patient outcomes. The Japanese Ministry of Health and Welfare (JMHW) and the International Society on Thrombosis and Haemostasis (ISTH) criteria are the most specific for diagnosis of septic DIC. The revised Japanese Association for Acute Medicine (JAAM) criteria are able to diagnose sepsis-induced DIC in the early stage. Recombinant human soluble thrombomodulin (rhTM) has recently been used for treating DIC. Previous studies have shown a benefit of using rhTM for D,IC diagnosed by the JMHW or ISTH criteria, but not the JAAM criteria. The purpose of this study was to sequentially evaluate coagulation biomarkers and the DIC score after giving rhTM treatment to patients with sepsis-induced DIC diagnosed according to the JAAM criteria.

Methods

We performed a retrospective cohort study. Critically ill patients were included if diagnosed with sepsis-induced DIC according to the JAAM criteria. They were either treated without rhTM (control group) or with rhTM (treatment group). The primary outcome was the DIC score on day 7. The secondary outcome was 28-day mortality from the start of DIC treatment. Changes in the results of coagulation tests were assessed over time from the start of treatment to day 7.

Results

Twelve and 23 patients were assigned to the treatment and control groups, respectively. The DIC score on day 7 was significantly higher in the treatment group (3.3 ± 1.4) than in the control group (4.9 ± 1.8, p < 0.05). Estimated survival showed lower in treatment group than control group. There was significant difference between the control group and the treatment group (p < 0.05). The D-dimer level on day 7 was significantly lower in the treatment group (7.5 ± 4.1 μg/mL) than in the control group (30.9 ± 33.6 μg/mL, p < 0.05). Life-threatening bleeding did not occur. Our results indicated that rhTM improved sepsis-induced DIC and mortality.

Conclusions

Recombinant human soluble thrombomodulin may improve sepsis-induced DIC diagnosed according to the JAAM criteria without an increased bleeding risk.

【 授权许可】

   
2013 Kato et al; licensee BioMed Central Ltd.

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