Effects of combination therapy using antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation.
Effects of combination therapy using antithrombin and thrombomodulin for sepsis-associated disseminated intravascular coagulation.
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DOI：
10.1186/s13613-017-0332-z
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发表时间：
2017-11-02
影响因子：
8.1
通讯作者：
Gando S
中科院分区：
文献类型：
--
作者：
Iba T;Hagiwara A;Saitoh D;Anan H;Ueki Y;Sato K;Gando S
没有单一的抗凝剂已被证明是有效的败血症相关的弥散性血管内凝血（DIC）。因此，已考虑合并使用抗凝血酶浓缩物和重组血栓调节蛋白。本观察性研究旨在研究该联合治疗的疗效和安全性。对510例接受抗凝血酶替代治疗的脓毒性DIC患者进行回顾性分析。其中，228例接受抗凝血酶和重组血栓调节蛋白（联合治疗），其余接受抗凝血酶单药治疗（单药治疗）。倾向评分匹配创建了129个匹配对，并比较了28天全因死亡率、DIC评分、序贯器官衰竭评估（SOFA）评分和出血发生率。对数秩检验显示，在配对中，联合治疗与较低的28天死亡率之间存在显著相关性（风险比0.49，95%置信区间0.29 - 0.82，P = 0.006）。第4天和第7天，联合治疗组的DIC评分和SOFA评分均显著低于单药治疗组。两组的出血发生率无差异（2.11 vs. 2.31%，P = 1.000）。目前的研究证明了在抗凝血酶中加入重组血栓调节蛋白的潜在获益。这两种抗凝剂的联合给药与脓毒症诱导的DIC患者的死亡率降低相关，而不增加出血风险。本文的在线版本（10.1186/s13613 - 017 - 0332-z）包含补充材料，可供授权用户使用。
No single anticoagulant has been proven effective for sepsis-associated disseminated intravascular coagulation (DIC). Thus, the concomitant use of antithrombin concentrate and recombinant thrombomodulin has been conceived. This observational study was conducted to investigate the efficacy and safety of this combination therapy. A total of 510 septic DIC patients who received antithrombin substitution were retrospectively analyzed. Among them, 228 were treated with antithrombin and recombinant thrombomodulin (combination therapy) and the rest were treated with antithrombin alone (monotherapy). Propensity score matching created 129 matched pairs, and 28-day all-cause mortality, DIC scores, the sequential organ failure assessment (SOFA) scores, and the incidence of bleeding were compared. A log-rank test revealed a significant association between combination therapy and a lower 28-day mortality rate (hazard ratio 0.49, 95% confidence interval 0.29–0.82, P = 0.006) in the matched pairs. The DIC scores and the SOFA scores in the combination therapy group were significantly lower than those in the monotherapy group on Day 4 and Day 7. The incidence of bleeding did not differ between the groups (2.11 vs. 2.31%, P = 1.000). The current study demonstrated the potential benefit of adding recombinant thrombomodulin to antithrombin. The co-administration of these two anticoagulants was associated with reduced mortality among patients with sepsis-induced DIC without increasing the risk of bleeding. The online version of this article (10.1186/s13613-017-0332-z) contains supplementary material, which is available to authorized users.
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影响因子：
2.9
作者：
Hagiwara A;Tanaka N;Uemura T;Matsuda W;Kimura A
通讯作者：
Kimura A
影响因子：
2.9
作者：
Iba, Toshiaki;Gando, Satoshi;Kuroda, Yasuhiro
通讯作者：
Kuroda, Yasuhiro
DOI：
10.1186/s13054-015-0810-3
发表时间：
2015-03-03
期刊：
Critical care (London, England)
影响因子：
--
作者：
Yoshimura J;Yamakawa K;Ogura H;Umemura Y;Takahashi H;Morikawa M;Inoue Y;Fujimi S;Tanaka H;Hamasaki T;Shimazu T
通讯作者：
Shimazu T
临床综述：抗凝血酶在败血症中作用的分子机制。
DOI：
10.1186/cc4822
发表时间：
2006-02
期刊：
Critical care (London, England)
影响因子：
--
作者：
Wiedermann CJ
通讯作者：
Wiedermann CJ
影响因子：
15.1
作者：
Iba, Toshiaki;Nakarai, Etsuro;Ohno, Yoichi
通讯作者：
Ohno, Yoichi