Recombinant soluble thrombomodulin for postoperative disseminated intravascular coagulation

Hashimoto, Daisuke; Chikamoto, Akira; Miyanari, Nobutomo; Ohara, Chitoshi; Kuramoto, Masafumi; Horino, Kei; Ohshima, Hisami; Baba, Hideo

doi:10.1016/j.jss.2015.04.048

Cited by 8 publications

(15 citation statements)

References 19 publications

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“…In the survival analysis, the overall survival rate at 28 d (71%) was similar to previous findings[ 4 ]. On the other hand, the survival rate of patients administered TM-α at 2 d after the DIC diagnosis was slightly worse (74% vs 50%).…”

Section: Discussionsupporting

confidence: 88%

“…DIC is not prevalent in the field of gastrointestinal surgery, but it is life-threating once it develops[ 4 ]. Early intensive care, including the administration of anti-thrombin concentrates and γ-globulin agents, has been shown to effectively improve the prognosis of patients with DIC[ 13 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In the future, the comparisons with other criteria, such as the International Society for Thrombosis and Haemostasis DIC score, will be needed. In previous studies, DIC patients treated with TM-α for approximately 6 d have been commonly evaluated[ 4 , 10 ], while patients in the present study were treated for shorter or longer durations. Some of our patients who were administered TM-α for a shorter duration showed amelioration of the DIC, whereas many patients with a shorter or longer duration of administration had worse prognoses.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have determined the efficacy of TM-α treatments for DIC associated with gastroenterological surgery[ 4 , 5 ]; however, the data are still insufficient to establish the optimal therapeutic strategies for hematological malignancies or infections such as sepsis. The optimal initiation time or duration of the administration of TM-α and the predictive factors for therapeutic efficacy remain unclear for actual clinical practice.…”

Section: Introductionmentioning

confidence: 99%

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

Konishi

Okamoto

Shoda

et al. 2017

WJG

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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.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Konishi

Okamoto

Shoda

et al. 2017

WJG

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“…Several studies have shown that rhTM improves coagulopathy in disseminated intravascular coagulation [ 28 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

Recombinant human soluble thrombomodulin improves mortality in patients with sepsis especially for severe coagulopathy: a retrospective study

Kato

Matsuura

2018

Thrombosis J

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BackgroundDisseminated intravascular coagulation (DIC) is associated with high mortality in patients with sepsis. Several studies reporting that recombinant human soluble thrombomodulin (rhTM) reduced mortality in sepsis patients. This retrospective cohort study aimed to evaluate the efficacy of rhTM for patients with mild coagulopathy compared with those with severe coagulopathy.MethodsWe evaluated about 90-day mortality and SOFA score. SOFA score was also evaluated for the following components: respiratory, cardiovascular, hepatic, renal and coagulation.ResultsAll 69 patients were diagnosed with sepsis, fulfilled Japanese Association for Acute Medicine criteria for DIC, and were treated with rhTM. Patients were assigned to either the mild coagulopathy group (did not fulfill the International Society on Thrombosis and Haemostasis overt DIC criteria) or the severe coagulopathy group (fulfilled overt DIC criteria). The 90-day mortality was significant lower in severe coagulopathy group than mild coagulopathy group (P = 0.029). Although the SOFA scores did not decrease in the mild coagulopathy group, SOFA scores decreased significantly in the severe coagulopathy group. Furthermore the respiratory component of the SOFA score significant decreased in severe coagulopathy group compared with mild coagulopathy group.ConclusionsrhTM administration may reduce mortality by improving organ dysfunction especially for respiratory in septic patients with severe coagulopathy.

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Recombinant human soluble thrombomodulin and short-term mortality of infection patients with DIC: a meta-analysis

Zhang

Wang

Yang

et al. 2016

The American Journal of Emergency Medicine

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Recombinant soluble thrombomodulin for postoperative disseminated intravascular coagulation

Cited by 8 publications

References 19 publications

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

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

Recombinant human soluble thrombomodulin improves mortality in patients with sepsis especially for severe coagulopathy: a retrospective study

Recombinant human soluble thrombomodulin and short-term mortality of infection patients with DIC: a meta-analysis

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