A summary of the Japan septic disseminated intravascular coagulation study

Hayakawa, Mineji; Ono, Kota

doi:10.1002/ams2.326

Cited by 15 publications

(14 citation statements)

References 37 publications

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“…Indeed, guidelines and consensus have not strongly recommended these drugs for the treatment of DIC, whatever the etiology (9-11). These results are generally consistent with a recent nationwide multicenter retrospective observational study of sepsis-induced DIC in Japan (44).…”

Section: Discussionsupporting

confidence: 92%

Anticoagulant Therapy for Disseminated Intravascular Coagulation After Gastrointestinal Surgery

et al. 2018

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Many studies about anticoagulant therapy for disseminated intravascular coagulation (DIC) confused gastrointestinal surgery-related DIC with DIC unrelated to a prior operation. Furthermore, the potentially increased risk of bleeding by anticoagulants complicates their use. We carried out a systematic review to describe the efficacy and safety of anticoagulant agents for DIC after gastrointestinal surgery. Several studies have indicated that gabexate mesylate improves DIC score without increasing bleeding events, and that antithrombin is associated with lower mortality of DIC after gastrointestinal surgery. Recombinant thrombomodulin has been the most frequently analyzed anticoagulant agent in this field. DIC score and survival rate were better in patients treated with recombinant thrombomodulin, without increasing bleeding events. In conclusion, anticoagulant therapy may be effective and safe in DIC after gastrointestinal surgery. Disseminated intravascular coagulation (DIC) frequently occurs in association with severe infections such as sepsis and malignancies (1, 2). Sepsis-induced DIC is a lifethreatening condition that involves systemic activation of blood coagulation that leads to the generation of intravascular fibrin, followed by multiple organ dysfunction syndrome, or even death (3, 4).Elective gastroenterological operations for malignancies usually lead to systemic inflammation and severe postoperative complications, such as intra-abdominal abscess formation, anastomotic leakage, pneumonia, and acute respiratory distress syndrome, and these conditions can be associated with DIC (5, 6). Moreover, emergency gastroenterological surgeries for an abdominal injury, perforation of ulceration, diverticulitis, or malignancies are associated with high morbidity and mortality rates, and postoperative sepsis and DIC often occur in such patients (7,8). These operations are necessary to improve patients' conditions. However, such operations themselves are highly invasive. Therefore, the response of the patients to treatment for gastroenterological surgery-related DIC may differ from that for DIC unrelated to a prior surgery.Recently, guidelines and consensus for the diagnosis and treatment of DIC were published in the United Kingdom (9), Japan (10), and Italy (11). These guidelines have mentioned various anticoagulant regents such as unfractionated heparin (UFH), low-molecular weight heparin (LMWH), danaparoid sodium (DS), gabexate mesylate (GM), nafamostat mesylate (NM), antithrombin (AT), and recombinant thrombomodulin (rhTM) (9-11). However, among the national guidelines, some differences in the recommendations for anticoagulant therapies exist. Additionally, many previous studies about the effects of various anticoagulant therapies on DIC confused DIC which was associated with gastroenterological surgery with DIC which was unrelated to an operation (12, 13). Furthermore, the potentially increased risk of bleeding as an adverse event of anticoagulant therapies has never been discussed in the treatment for DIC that ...

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Section: Discussionsupporting

confidence: 92%

Anticoagulant Therapy for Disseminated Intravascular Coagulation After Gastrointestinal Surgery

et al. 2018

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“…Several analyses have already been conducted and studies have been published using this data set 11–16 , 18–20 , 25–28 .…”

Section: Methodsmentioning

confidence: 99%

Nationwide registry of sepsis patients in Japan focused on disseminated intravascular coagulation 2011–2013

et al. 2018

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Sepsis is a syndrome with physiologic, pathologic, and biochemical abnormalities induced by infection. Sepsis can induce the dysregulation of systemic coagulation and fibrinolytic systems, resulting in disseminated intravascular coagulation (DIC), which is associated with a high mortality rate. Although there is no international consensus on available treatments for sepsis-induced DIC, DIC diagnosis and treatment are commonly performed in Japanese clinical settings. Therefore, clinical data related to sepsis-induced DIC diagnosis and treatment can be obtained from Japanese clinical settings. We performed a retrospective nationwide observational study (Japan Septic Disseminated Intravascular Coagulation [J-SEPTIC DIC] study) to collect data regarding characteristics of sepsis patients in Japan, with a focus on coagulofibrinolytic dysregulation and DIC treatment received by each patient. The J-SEPTIC DIC study collected information for a total of 3,195 patients with severe sepsis and septic shock and is the largest data set in Japan on DIC diagnosis and treatment in clinical settings.

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“…It presented survival curves according to patient profiles when anticoagulant therapy was applied. Improvement was observed only in the survival curve of patients with septic DIC or SOFA scores of 13-17 [13]. From these reviews, anticoagulants may be effective only for septic DIC, not for sepsis without DIC.…”

Section: Consistency Of Evidencementioning

confidence: 99%

A question is “what are the optimal targets for anticoagulant therapies?”

et al. 2020

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A high mortality rate is found among septic patients with disseminated intravascular coagulation (DIC). Anticoagulants have been used for treating septic DIC especially in Japanese clinical settings; however, their effectiveness is quite controversial across studies. According to several randomized controlled trials and metaanalyses, antithrombin and recombinant thrombomodulin had no therapeutic benefit in the treatment of sepsis. However, the majority of the previous research did not discuss "septic DIC" but simply "sepsis", and some reviews showed that anticoagulants were benefit only in septic DIC. Although immunothrombosis plays an important role in early host defense, it can lead to DIC and organ failure if dysregulated. Therefore, we advocate anticoagulant therapies might have beneficial effects, but research on optimal patient selection is currently lacking.

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A summary of the Japan septic disseminated intravascular coagulation study

Cited by 15 publications

References 37 publications

Anticoagulant Therapy for Disseminated Intravascular Coagulation After Gastrointestinal Surgery

Anticoagulant Therapy for Disseminated Intravascular Coagulation After Gastrointestinal Surgery

Nationwide registry of sepsis patients in Japan focused on disseminated intravascular coagulation 2011–2013

A question is “what are the optimal targets for anticoagulant therapies?”

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