ArticleThrombosis journal2025
Controversial efficacy of antithrombin followed by recombinant thrombomodulin administration in patients with sepsis-induced disseminated intravascular coagulation: an analysis of postmarketing surveillance data.
Article in Thrombosis journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundAnticoagulant therapy is considered useful for sepsis patients with disseminated intravascular coagulation (DIC); however, the efficacy of combination therapy with anticoagulants is still under investigation.
methodsWe evaluated anticoagulant use in 1,770 patients with sepsis-induced DIC from 314 institutions by analyzing postmarketing survey data on plasma-derived antithrombin (AT) concentrates. DIC was defined as a DIC score above 4 according to the Japanese Association for Acute Medicine (JAAM). We divided patients into quartiles according to JAAM-defined DIC and Sequential Organ Failure Assessment (SOFA) scores to determine the efficacy of concomitant recombinant thrombomodulin (rTM) following AT supplementation, and we performed a propensity score-adjusted analysis.
resultsThe 28-day mortality rate after AT administration was 24.1%. We categorized patients on the basis of a JAAM-defined DIC score of 6 and a SOFA score of 9, because the patients' median JAAM-defined DIC and SOFA scores were 5 and 9, respectively. Among patients with JAAM-defined DIC scores >6 and SOFA scores >9, patients treated with AT followed by rTM (concomitant rTM use) had a significantly lower mortality rate (28.5%) than did those treated without concomitant rTM (40.0%) (p = 0.031). However, among patients with JAAM-defined DIC scores of four or five, the patients treated with concomitant rTM had a significantly greater mortality rate than did those not treated with concomitant rTM, irrespective of whether their SOFA score was below or above 9 (18.5% vs. 10.1%, p = 0.036 and 37.0% vs. 24.3%, p = 0.018, respectively). The incidence of serious bleeding- related adverse events did not differ between patients with and without concomitant rTM treatment.
conclusionsefficacy of rTM administration following AT supplementation in patients with sepsis-induced DIC is controversial, and the evidence is restricted to decreasing mortality rates in patients with JAAM-defined DIC scores >6 and SOFA scores>9. However, further studies are needed to confirm these findings.
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