Efficacy and Bleeding Risk of Antithrombin Supplementation in Patients With Septic Disseminated Intravascular Coagulation: A Third Survey

Iba, Toshiaki; Gando, Satoshi; Saitoh, Daizoh; Anan, Hideaki; Oda, Shigeto; Kitamura, Nobuya; Mori, Shigeru; Kotani, Joji; Kuroda, Yasuhiro

doi:10.1177/1076029616648405

Cited by 16 publications

(19 citation statements)

References 35 publications

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“…The concomitant use of heparin leads to decreased AT binding to glycosaminoglycans on cells membranes, reduces its anti-inflammatory action and endothelium-protective action [ 12 ]. A subsequent analysis, (Kienast et al 2006) of a subgroup of patients with DIC and without heparin use, revealed decreased mortality at twenty-eight days [ 35 ] and corroborated the results from other trials and meta-analysis [ 36 , 37 , 38 , 39 ]. Monitoring AT levels offers guidance in the selection of patients and appropriate dosages [ 40 ].…”

Section: Antithrombinmentioning

confidence: 53%

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Scărlătescu

Tomescu

Aramă

2017

The Journal of Critical Care Medicine

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Sepsis associated coagulopathy is due to the inflammation-induced activation of coagulation pathways concomitant with dysfunction of anticoagulant and fibrinolytic systems, leading to different degrees of haemostasis dysregulation. This response is initially beneficial, contributing to antimicrobial defence, but when control is lost coagulation activation leads to widespread microvascular thrombosis and subsequent organ failure. Large clinical trials of sepsis-related anticoagulant therapies failed to show survival benefits, but posthoc analysis of databases and several smaller studies showed beneficial effects of anticoagulants in subgroups of patients with early sepsis-induced disseminated intravascular coagulation. A reasonable explanation could be the difference in timing of anticoagulant therapy and patient heterogeneity associated with large trials. Proper selection of patients and adequate timing are required for treatment to be successful. The time when coagulation activation changes from advantageous to detrimental represents the right moment for the administration of coagulation-targeted therapy. In this way, the defence function of the haemostatic system is preserved, and the harmful effects of overwhelming coagulation activation are avoided.

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Section: Antithrombinmentioning

confidence: 53%

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Scărlătescu

Tomescu

Aramă

2017

The Journal of Critical Care Medicine

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“…As hypo brinogenemia is frequently related to the bleeding tendency in hematological diseases patient with DIC and organ failure is often associated with infectious disease patient with DIC, hypo brinogenemia is considered to be frequently associated with DIC in patients with hematological diseases but rarely with DIC in patients with infectious disease [5,14]. However, some septic cases have been reported to be associated with severe bleeding [23,24]. Our analysis of the PMS data revealed that hypo brinogenemia was present in 10.3% of infectious diseases with DIC and suspected DIC, suggesting that hypo brinogenemia is sometimes associated with infectious-type DIC.…”

Section: Discussionmentioning

confidence: 99%

Hypofibrinogenemia is Associated With a High Degree of Risk in Infectious and Hematological Diseases: A Post-Hoc Analysis of Post-Marketing Surveillance of Patients With Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa

Kawasugi

Wada

Honda

et al. 2020

Preprint

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Introduction In patients with infectious diseases, disseminated intravascular coagulation (DIC) is often diagnosed without the fibrinogen value and the relationship between hypofibrinogenemia and the outcomes of infectious DIC has remained unclear.Materials and Methods We analyzed 3204 patients who received with thrombomodulin alfa (TM-α) for with DIC and suspected DIC. Hypofibrinogenemia was defined by a fibrinogen level of <1.5 g/L.Results Hypofibrinogenemia was observed in 10.3% of patients with infectious diseases. The frequencies of both bleeding and organ failure symptoms, and the scores for organ failure or the DIC diagnostic criteria were significantly high in infectious disease patients with hypofibrinogenemia, suggesting that in patients with infectious diseases, hypofibrinogenemia is associated with more progressive and severe DIC. Although the 28-day survival rate and the DIC resolution rate were both significantly lower in infectious disease patients with DIC with hypofibrinogenemia than in those without hypofibrinogenemia, this difference was not observed in DIC patients with hematological diseases.Conclusion In infectious disease patients with DIC, hypofibrinogenemia may reflect from the increased consumption of fibrinogen due to an accelerated coagulating reaction, while that in hematological disease patients DIC may be caused by fibrinogenolysis due to hyperfibrinolysis, and frequently results in bleeding and multiple-organ failure.

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“…Coagulation function is the key to determine the condition of perioperative bleeding of patient, and keeping patient's coagulation function in a stable state is the fundamental solution to reduce the occurrence of operating massive hemorrhage in patients (11). During the operation, traumatic invasive procedures, blood loss in vitro , oxidative reaction in the body and the various aspects of factors could cause coagulopathy in patient (12–14).…”

Section: Discussionmentioning

confidence: 99%

Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient

Shi

et al. 2019

Exp Ther Med

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Application value of thromboelastography (TEG) in perioperative clinical blood transfusion and its effect on the outcome of patient were investigated. Seventy-four patients, admitted to The Surgical Department of the First Hospital of Zibo from March 2015 to March 2018, were selected for this study. Among them, 34 patients took only the traditional coagulation function testing method as the blood transfusion guide during the perioperative period and they were regarded as the control group. The other 40 patients used TEG as the blood transfusion guide during the perioperative period, and they were regarded as the TEG group. The coagulation function indicators in 2 h before the operation and in 24 h after the operation, the transfusion amount and blood loss during the operation, the condition of the blood transfusion during the perioperative period, the occurrence rate of the postoperative rebleeding, the length of hospital stay and mortality of the patients in the two groups were compared. The coagulation function indicators of the patients in the two groups in 2 h before the operation and in 24 h after the operation showed that there was no significant difference between the two groups (P>0.050). However, APTT and Pt of the patients in the two groups both increased when compared with those before the treatment (P<0.050) and Hb, Hct, Plt and Fib all decreased (P<0.050). The suspended erythrocytes, Plt, fibrinogen and plasma in the TEG group were both significantly lower than those in the control group (P<0.001). Compared with the traditional coagulation function test, TEG was more accurate for estimating the coagulation function of patient and was more suitable for estimating the condition of blood transfusion of patient in the perioperative period; also, it could shorten the recovery period of patient and it is worthwhile to promote it in the clinic.

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Efficacy and Bleeding Risk of Antithrombin Supplementation in Patients With Septic Disseminated Intravascular Coagulation: A Third Survey

Abstract: The coadministration of rTM may improve survival without increasing the risk of bleeding in patients with sepsis-associated DIC treated with AT.

Cited by 16 publications

References 35 publications

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Review. Anticoagulant Therapy in Sepsis. The Importance of Timing

Hypofibrinogenemia is Associated With a High Degree of Risk in Infectious and Hematological Diseases: A Post-Hoc Analysis of Post-Marketing Surveillance of Patients With Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa

Application value of thromboelastography in perioperative clinical blood transfusion and its effect on the outcome of patient

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