Efficacy and Bleeding Risk of Antithrombin Supplementation in Patients With Septic Disseminated Intravascular Coagulation: A Third Survey
Efficacy and Bleeding Risk of Antithrombin Supplementation in Patients With Septic Disseminated Intravascular Coagulation: A Third Survey
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DOI：
10.1177/1076029616648405
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发表时间：
2017-07-01
影响因子：
2.9
通讯作者：
Kuroda, Yasuhiro
中科院分区：
文献类型：
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作者：
Iba, Toshiaki;Gando, Satoshi;Kuroda, Yasuhiro
前言：虽然最近的研究报道了抗凝血酶(AT)对脓毒症相关性弥散性血管内凝血(DIC)的疗效，但影响AT疗效的因素还没有得到充分的研究。本次调查的目的是确定影响药物不良反应的因素。方法：我们进行了一项多机构的调查。对159例感染性DIC患者进行AT补充治疗，其中AT占70%。分析患者的人口学特征，包括感染部位、基线败血症相关器官衰竭评估(SOFA)评分、基线DIC评分和基线AT活动与28天死亡率的关系。结果：总体上，116例患者存活，43例死亡(28天死亡率：27.0%)。Logistic回归分析显示，基线SOFA评分(优势比[OR]：0.816，P=.001)、联合应用重组血栓调节蛋白(OR：3.989，P=.006)和呼吸道感染(OR：0.129，P=.000)与生存率显著相关。存活者的AT活性峰值高于死亡者(85.1%比65.0%，P=.027)。有4.13%的患者发生出血事件(大出血：1.65%)，联合应用RTM并不增加出血风险(有RTM：4.11%与不使用RTM：4.17%)。22例(18.2%)同时使用肝素，其出血风险无显著增加(使用肝素：9.09%与不使用肝素：3.03%；P=.224)。结论：联合应用RTM可在不增加AT治疗的出血风险的情况下，提高脓毒症相关性DIC患者的存活率。
Introduction: Although recent studies have reported the efficacy of antithrombin (AT) supplementation for sepsis-associated disseminated intravascular coagulation (DIC), the factors that influence AT's effect have not been sufficiently studied. The purpose of this survey was to identify factors that modulate the effects and the adverse effects of AT.Methods: We performed a multi-institutional survey. The data from 159 patients with septic DIC with AT 70% and who had undergone AT supplementation were analyzed. The patients' demographic characteristics, including the infection site, baseline sepsis-related organ failure assessment (SOFA) score, baseline DIC score, and baseline AT activity, were analyzed in relation to the 28-day mortality. Bleeding-related adverse events were also examined.Results: Overall, 116 patients survived and 43 did not (28-day mortality: 27.0%). A logistic regression analysis revealed that the baseline SOFA score (odds ratio [OR]: 0.816, P = .001), coadministration of recombinant thrombomodulin (rTM; OR: 3.989, P = .006), and respiratory tract infection (OR: 0.129, P = .000) were significantly associated with the survival. Survivors exhibited a higher peak AT activity than nonsurvivors (85.1% vs 65.0%, P = .027). Bleeding events were observed in 4.13% (major bleeding: 1.65%) of the patients, and the coadministration of rTM did not increase the risk of bleeding (with rTM: 4.11% vs without rTM: 4.17%). Heparin was concomitantly used in 22 (18.2%) cases, and its use nonsignificantly increased the bleeding risk (with heparins: 9.09% vs without heparins: 3.03%; P = .224).Conclusion: The coadministration of rTM may improve survival without increasing the risk of bleeding in patients with sepsis-associated DIC treated with AT.