Sepsis-Associated DIC with Decreased Levels of Antithrombin and Fibrinogen is the Target for Combination Therapy with Thrombomodulin Alfa and Antithrombin.
Sepsis-Associated DIC with Decreased Levels of Antithrombin and Fibrinogen is the Target for Combination Therapy with Thrombomodulin Alfa and Antithrombin.
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DOI：
10.1055/a-2009-9073
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发表时间：
2023-01
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弥散性血管内凝血（DIC）不是一种同质性疾病，而是包括异质性疾病，其病理生理和结局因背景而有很大差异。虽然抗凝治疗有望对DIC的治疗有益，但先前的研究表明，这种益处仅限于特定的亚型。目的：本研究的目的是确定血栓调节素/抗凝血酶联合治疗的获益组。方法对2839例血栓调节素上市后监测患者资料进行评价。根据抗凝血酶和纤维蛋白原水平将患者分为四组，观察各组抗凝血酶对凝血调节蛋白的加性作用。结果低抗凝血酶/低纤维蛋白原DIC组的DIC评分、序贯器官衰竭评分和死亡率明显高于无低抗凝血酶/低纤维蛋白原DIC组。联合治疗的DIC患者的生存曲线明显高于单药治疗的患者，但这种效果仅见于感染型DIC患者。结论低抗凝血酶/低纤维蛋白原的DIC患者预后较差，但只要是感染引起的DIC，抗凝血酶和凝血调节蛋白可以作为联合治疗的目标。
Background Disseminated intravascular coagulation (DIC) is not a homogeneous condition, but rather includes heterogeneous conditions, and its pathophysiology and outcome vary considerably depending on the background. Although anticoagulant therapy is expected to be of benefit in the treatment of DIC, previous studies have suggested that the benefits are limited only to a specific subtype. Objects The purpose of this study was to identify the group that would benefit from combination therapy using thrombomodulin/antithrombin. Methods The data from 2,839 patients registered in the postmarketing surveillance of thrombomodulin were evaluated. The patients were divided into four groups depending on antithrombin and fibrinogen levels, and the additive effects of antithrombin on thrombomodulin were examined in the groups. Results The DIC score, Sequential Organ Failure Assessment score, and mortality were significantly higher in the DIC group with low-antithrombin/low-fibrinogen than in the DIC groups without either low antithrombin or low fibrinogen. The survival curve was significantly higher in DIC patients with combination therapy than in patients treated with thrombomodulin monotherapy, but this effect was seen only in patients with infection-based DIC. Conclusion DIC patients with low-antithrombin/low-fibrinogen risk poor outcomes, but they can be the target of combination therapy with antithrombin and thrombomodulin as long as the DIC is due to infection.