Recombinant soluble thrombomodulin: coagulation takes another chance to reduce sepsis mortality

Abstract

To cite this article: Levi M. Recombinant soluble thrombomodulin: coagulation takes another chance to reduce sepsis mortality. J Thromb Haemost 2015; 13: 505-7.See also Yamakawa K, Aihara M, Ogura H, Yuhara H, Hamasaki T, Shimazu T. Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta-analysis. This issue, pp 508-19.

Biocompatible coupling of therapeutic fusion proteins to human erythrocytes

“…TM shows promise in the treatment of sepsis, 53 and RBC-coupled TM has demonstrated superiority to soluble TM in mouse models. 20,21 Coupling TM to either epitope resulted in efficacious RBC drug carriers as measured by enzymatic activity and in a humanized microfluidic model of inflammatory thrombosis.…”

Should all patients with sepsis receive anticoagulation? Yes

“…Blood coagulation therefore may be a potentially interesting therapeutic target in sepsis and septic shock, to prevent or counteract excessive coagulation activation [4]. Significant reductions in the endogenous anticoagulants protein C and antithrombin correlate with DIC severity.…”

ICAM-1–targeted thrombomodulin mitigates tissue factor–driven inflammatory thrombosis in a human endothelialized microfluidic model

“…[1][2][3][4] The thrombotic process that occurs in the setting of infection or activation of the immune response is recognized as having distinct elements, which distinguish it from normal hemostasis or even other forms of arterial or venous thrombosis. 5 While agents such as antithrombin III and activated protein C (APC) initially held promise in treating sepsis, their clinical utility has been limited by a lack of efficacy and bleeding risks, 6,7 and the benefit of more standard anticoagulants such as heparin is uncertain.…”