Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

Abstract

AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.METHODSThirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.RESULTSAbscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

Surgery-related disseminated intravascular coagulation predicts postoperative complications

“…However, surgery-related DIC is not still prevalent in the field of gastrointestinal surgery [ 30 ], and it is challenging to treat surgery-related DIC in Japan because of the risk of postoperative bleeding. However, only a few studies have reported that recombinant soluble thrombomodulin improved surgery-related DIC [ 30 , 31 ]. Hashimoto et al reviewed that anticoagulant therapy may be effective and safe in DIC after gastrointestinal surgery [ 32 , 33 ].…”

Anticoagulant Therapy for Disseminated Intravascular Coagulation After Gastrointestinal Surgery

“…The 28-day survival rate of the rhTM group was better than the control group in two studies (24,29). Additionally, the incidence of bleeding events as an adverse effect was not increased (21,29,30). No studies of DIC after gastrointestinal surgery have focused on the effect of UFH, LMWH, DS, or NM.…”

“…One of those indicated that treatment with AT was associated with better prognosis in propensity score-matched analysis; however, this study was not able to evaluate clinical data, including DIC score, plasma AT level, and bleeding events (25). rhTM has been the most frequently analyzed anticoagulant agent in DIC after gastrointestinal surgery (21,24,(29)(30)(31). Acute DIC score was improved by rhTM in three studies (21,29,30).…”

“…rhTM has been the most frequently analyzed anticoagulant agent in DIC after gastrointestinal surgery (21,24,(29)(30)(31). Acute DIC score was improved by rhTM in three studies (21,29,30). The 28-day survival rate of the rhTM group was better than the control group in two studies (24,29).…”

“…Konishi et al retrospectively investigated the efficacy of rhTM for treatment of 36 perioperative DIC patients after gastrointestinal surgery (30). Abscess formation and bacteremia were the most frequent causes of DIC.…”