Effects of Recombinant Human Soluble Thrombomodulin Treatment for Disseminated Intravascular Coagulation at a Single Institution -An Analysis of 62 Cases Caused by Infectious Diseases and 30 Cases Caused by Hematological Diseases

Abstract

Objective Disseminated intravascular coagulation (DIC) is a clinical condition with high mortality that is characterized by the systemic activation of coagulation pathways resulting in multiple organ failure. Although no standard treatment for DIC has been established, recent reports have indicated that recombinant human soluble thrombomodulin (rTM) is effective against DIC. Methods To elucidate the clinical characteristics and outcomes of DIC, we retrospectively analyzed 92 DIC patients who were treated with rTM at Miyazaki Prefectural Hospital over a 4-year period (62 patients had infectious diseases and 30 patients had hematological diseases). A diagnosis of DIC was made based on the diagnostic criteria of the Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW) for infectious diseases and hematological diseases, respectively. In addition to treating the underlying disease, rTM was administered for six consecutive days. Results In this study, 49 of the 92 DIC patients (53.3%) experienced resolution of DIC seven days after administration (46.8% patients with infectious disease and 66.7% with hematological disease). A higher survival rate was observed after a 28-day observation period in 69 of the 92 patients (75.0%) (72.6% of the patients with infectious disease and 80.0% of the patients with hematological disease). A lower DIC score at the initiation of rTM treatment was closely related to a higher rate of resolution of DIC. Conclusion Our findings indicate that rTM therapy is an effective, safe and feasible treatment for DIC patients. Furthermore, making an accurate and early diagnosis of DIC and providing subsequent immediate treatment with rTM may improve the resolution of DIC.Key words: disseminated intravascular coagulation, recombinant human soluble thrombomodulin, the criteria of the Japanese Association for Acute Medicine, the criteria of the Japanese Ministry of Health and Welfare, early treatment at a low score of DIC

Clinical Treatment of Perioperative Disseminated Intravascular Coagulation in Patients Who Underwent Gastrointestinal and Hepato-Biliary-Pancreatic Surgery

“…12 Moreover, the DIC score improved, and the pretreatment APACHE II score might be correlated with the survival rate. 13,14 The SOFA score is often used in clinical settings to evaluate sepsis and is useful for dynamically understanding the condition. 15 The mortality rate is 50% or higher in patients whose SOFA scores increase within 48 h after ICU admission.…”

Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis

“…This novel drug can improve the mortality rate and respiratory failure associated with severe sepsis. 11 , 12 To date, several studies of rTM for DIC with various diseases, such as acute pancreatitis 13 or hematological diseases, 14 , 15 have been reported. However, there have been a few reports of a clinical evaluation of rTM focused only on sepsis-induced DIC caused by acute cholangitis.…”

781 - Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis

“…This novel drug can improve the mortality rate and respiratory failure associated with severe sepsis. 11,12 To date, several studies of rTM for DIC with various diseases, such as acute pancreatitis 13 or hematological diseases, 14,15 have been reported. However, there have been a few reports of a clinical evaluation of rTM focused only on sepsis-induced DIC caused by acute cholangitis.…”