Antithrombin use and 28-day in-hospital mortality among severe-burn patients: an observational nationwide study

Abstract

BackgroundPrevious studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns.MethodsWe performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs).ResultsEligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2–28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37–0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference −3.7; 95% CI −7.2 to −0.12).ConclusionsThis nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.Electronic supplementary materialThe online version of this article (doi:10.1186/s13613-017-0244-y) contains supplementary material, which is available to authorized users.

Antithrombin concentrate use in sepsis‐associated disseminated intravascular coagulation: re‐evaluation of a ‘pendulum effect’ drug using a nationwide database

“…Several similar ‘unique evolution’ drugs, including antithrombin administration for DIC , recombinant human soluble thrombomodulin for DIC and intravenous immunoglobulin for sepsis , were previously evaluated using the Japanese Diagnosis Procedure Combination (DPC) database. Several experimental studies have suggested that these drugs are pharmacologically appropriate for the treatment of each pathophysiological condition.…”

“…medications, drip infusions, and several procedures, including surgeries) and the starting dates and duration of each treatment during hospitalization. These data allowed us to clearly define inclusion and exclusion criteria in our studies . We believe that the DPC database is, at least currently, the best available nationwide database for evaluating the effect of treatments that are used only in Japan.…”

“…We believe that the DPC database is, at least currently, the best available nationwide database for evaluating the effect of treatments that are used only in Japan. We thus tried to report these domestic data from Japan, regardless of the results (positive or negative results) and our (investigators’) own particular preferences .…”

“…Among the three DPC studies of the ‘supplemental dose’ of antithrombin for DIC patients , we first evaluated 9075 patients with severe pneumonia and sepsis‐associated DIC . A significant association was found between 28‐day mortality and antithrombin use using propensity‐score matched analysis (antithrombin use vs. control group: 40.6% vs. 44.2%, P = 0.02).…”

“…Instrumental variable analysis showed that the receipt of antithrombin was associated with a 6.5% (95% CI, 0.05–13.0) reduction in 28‐day mortality. The data from 3223 patients with severe burns (burn index >10) that were recently published reported that antithrombin use may improve 28‐day survival and increase ventilator‐free days.…”