ArticleJournal of anesthesia2026
Effect of combination therapy with recombinant thrombomodulin and antithrombin on outcomes in patients with sepsis-induced disseminated intravascular coagulation in a surgical intensive care unit: a retrospective observational study.
Article in Journal of anesthesia, 2026. 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
purposeSepsis-induced disseminated intravascular coagulation (DIC) is associated with high morbidity and mortality. We evaluated the association of recombinant thrombomodulin (rTM) plus antithrombin (AT) with outcomes in adults with sepsis-induced DIC treated in a surgical intensive care unit (ICU).
methodsWe conducted a single-center retrospective observational study between January 2018 and March 2025. Patients receiving rTM plus AT were compared with those receiving AT alone using 1:1 propensity-score matching. The primary outcome was 28-day all-cause mortality. Secondary outcomes included DIC resolution, ICU length of stay, and severe bleeding requiring transfusion. A predefined subgroup analysis evaluated patients undergoing surgery.
resultsAfter matching, 45 patient pairs were analyzed. 28-day mortality was 11.1% (5/45) in the rTM + AT group and 15.6% (7/45) in the AT monotherapy group (relative risk, 0.71; 95% confidence interval, 0.24-2.08; log-rank p = 0.53). DIC resolution was more frequent with combination therapy than with AT monotherapy (88.9% vs. 66.7%; p = 0.02), whereas ICU length of stay did not differ significantly. Severe bleeding occurred in 13.3% and 33.3% of patients, respectively (p = 0.04). In the surgical subgroup, 28-day mortality was 6.9% (2/29) vs. 16.0% (4/25; log-rank p = 0.31), while DIC resolution was 93.1% vs. 64.0% (p = 0.02). Severe bleeding occurred in 17.2% and 40.0%, respectively (p = 0.08).
conclusionCombination therapy with rTM and AT was associated with a higher rate of DIC resolution and a lower incidence of severe bleeding complications, including among surgical patients. However, no significant difference in 28-day mortality or ICU length of stay was observed.
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