Therapeutic effect of recombinant thrombomodulin on the hemostatic and inflammatory response in patients with septic DIC

Yada, Noritaka; Nishio, Kenji; Seki, Takahiro; Fukushima, Hidetada; Urizono, Yasuyuki; Hata, Michiaki; Okuchi, Kazuo

doi:10.3893/jjaam.22.749

Cited by 3 publications

(5 citation statements)

References 15 publications

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“…S2). The authors of eight of these studies were contac‐ted for further information about these changes. There was no difference between groups in the changes in FDP (mean difference, −11.7 μg mL −1 ; 95% CI, −32.9 to 9.5 μg mL −1 ; P = 0.28; I 2 = 32%).…”

Section: Resultsmentioning

confidence: 99%

“…B). The authors of five studies were contacted for further information about DIC resolution rates. There was a statistically significant increase in DIC resolution in the rhTM group compared with the control group (RR, 1.75; 95% CI, 1.43–2.16; P < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…Figure 1 shows the PRISMA flow chart of study selection in the systematic review. We identified 12 articles (three RCTs and nine observational studies) in our systematic review (pooled sample size, 1409 patients; 838 in RCTs and 571 in observational studies) [14,23,[25][26][27][28][29][30][31][32][33][34].…”

Section: Discussionmentioning

confidence: 99%

“…We wish to express our gratitude to Drs. Takahashi , Ohryorji , Yada , Kudo , Umegaki , Kato , Sawano , Yamato , and Sha , who provided additional data necessary for meta‐analytic calculations.…”

Section: Acknowledgementsmentioning

confidence: 99%

“…S3). The authors of these eight studies [26][27][28][29][30][31][32]34] were contacted for further information on platelet counts. There was a statistically significant increase in platelet count in the rhTM group compared with the control group (mean difference, 3.66 9 10 4 lL À1 ; 95% CI, 1.89-5.44 9 10 4 lL À1 ; P < 0.01; I 2 = 13%).…”

Section: Changes In Hemostatic Markersmentioning

confidence: 99%

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Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta‐analysis

Yamakawa

Aihara

Ogura

et al. 2015

Journal of Thrombosis and Haemostasis

143

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severe sepsis: a systematic review and meta-analysis. J Thromb Haemost 2015; 13: 508-19.See also Levi M. Recombinant soluble thrombomodulin: coagulation takes another chance to reduce sepsis mortality. This issue, pp 505-7.Summary. Background: Although recombinant human soluble thrombomodulin (rhTM) is a widely used novel anticoagulant agent for disseminated intravascular coagulation (DIC) in Japan, its clinical efficacy in sepsisinduced DIC has not been demonstrated convincingly. Objective: To assess the benefits and harms of rhTM in sepsis-induced DIC patients. Methods: We conducted a systematic review and meta-analysis of rhTM therapy for sepsis-induced DIC for both randomized controlled trials (RCTs) and observational studies (retrospective case-control studies and/or prospective cohort studies) separately. All-cause mortality (28-30 days) as efficacy and serious bleeding complications as adverse effect were measured as primary outcomes. We assessed body of evidence quality at the outcome level by using the Grading of Evidence, Assessment, Development and Evaluation (GRADE) approach. Results: We analyzed 12 studies (838 patients/3 RCTs; 571 patients/9 observational studies). Pooled relative risk was 0.81 (95% CI, 0.62-1.06) in the RCTs, indicating non-significant reduction in mortality, and 0.59 (95% CI, 0.45-0.77) in the observational studies. Meta-regression analysis revealed a significant negative slope between effect size of rhTM therapy and baseline mortality rate in individual studies (P = 0.012), suggesting that probability of a beneficial effect with rhTM therapy increases with increasing baseline risk. Risk of serious bleeding complications was not significantly different between rhTM and control groups. We judged the quality of evidence as moderate for mortality and serious bleeding. Conclusions: The rhTM was associated with a trend in reduction of mortality at 28-30 days in sepsis-induced DIC patients. Further large rigorous trials are needed to confirm or refute these findings before implications for practice are clear.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Acknowledgementsmentioning

confidence: 99%

Section: Changes In Hemostatic Markersmentioning

confidence: 99%

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Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta‐analysis

Yamakawa

Aihara

Ogura

et al. 2015

Journal of Thrombosis and Haemostasis

143

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Early differential diagnosis between thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC)

憲孝¹,

健治²

2020

Nihon Kessen Shiketsu Gakkaishi

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要約：血栓性微小血管症(thrombotic microangiopathy: TMA)は血小板減少・臓器障害・溶血性貧血を呈する比較的稀な病態であり，血栓性血小板減少性紫斑病(thrombotic thrombocytopenic purpura: TTP) ，志賀毒素産生大腸菌による溶血性尿毒症症候群(Shiga toxin-producing Escherichia coli-hemolytic uremic syndrome: STEC-HUS) ，非典型溶血性尿毒症症候群(atypical HUS: aHUS) ，二次性 TMA に分類される．類似の症状をきたす病態としては播種性血管内凝固(disseminated intravascular coagulation: DIC)の頻度が高く，TMA も DIC も早期治療が予後を左右するため，これらの早期鑑別が問題になることがある．血小板減少・臓器障害・溶血性貧血の診療においては TMA を疑うことが大切であり，そのために最も重要な点は溶血性貧血に気付くことである．溶血性貧血に気付くことが出来れば，ADAMTS13 活性など確定診断に必要な検査を提出し，その結果を得るまでに TMA および DIC の早期鑑別診断を進める．PLASMIC score，腸炎症状，原因疾患，家族歴・既往歴，溶血所見・凝固異常の程度などを指標に可能性の高い疾患を選び出して早期治療を開始しつつ，確定診断が得られるまでは常に他の TMA や DIC の可能性も念頭に置いて，治療経過の中で繰り返し判断することが重要である．

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Effectiveness of Human Recombinant Thrombomodulin for Septic Disseminated Intravascular Coagulation in Perioperative Care in Digestive Surgery

Sugase

Yamada

Okuyama

et al. 2014

Jpn J Gastroenterol Surg, Nihon Shokaki Geka Gakkai zasshi

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Therapeutic effect of recombinant thrombomodulin on the hemostatic and inflammatory response in patients with septic DIC

Cited by 3 publications

References 15 publications

Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta‐analysis

Recombinant human soluble thrombomodulin in severe sepsis: a systematic review and meta‐analysis

Early differential diagnosis between thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC)

Effectiveness of Human Recombinant Thrombomodulin for Septic Disseminated Intravascular Coagulation in Perioperative Care in Digestive Surgery

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