Efficacy and bleeding risk of antithrombin supplementation in septic disseminated intravascular coagulation: a secondary survey.
Efficacy and bleeding risk of antithrombin supplementation in septic disseminated intravascular coagulation: a secondary survey.
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DOI：
10.1186/s13054-014-0497-x
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发表时间：
2014-09-15
期刊：
影响因子：
--
通讯作者：
Asakura H
中科院分区：
文献类型：
--
作者：
Iba T;Saitoh D;Wada H;Asakura H
在以前的报告中，我们证明了在AT活性为70%或更低的患者中，以3，000 IU/天的剂量补充抗凝血酶（AT）浓缩物治疗脓毒症相关的弥散性血管内凝血（DIC）的趋势优于1，500 IU/天。由于生存差异未达到统计学显著性，我们计划在更多的重症病例中检验其效果。我们进行了一项非随机多机构调查。总共分析了307例AT活性低于40%的脓毒性DIC患者，这些患者连续3天接受了1，500 IU/天或3，000 IU/天剂量的AT替代治疗。其中，259例患者接受1，500 IU/天（AT 1500组），48例患者接受3，000 IU/天（AT 3000组）。主要疗效终点为第7天DIC恢复和第28天全因死亡。还检查了不良出血事件。使用年龄、性别、体重、初始AT活性、DIC评分、血小板计数、肝素联合给药、重组血栓调节蛋白、疑似感染源、手术和补充AT剂量进行logistic回归分析。与AT 1500组的结果相比，补充AT 3000组的DIC评分显著降低，导致DIC的上级消退（66.7% vs 45.2%，P = 0.007）。此外，AT 3000组的生存率优于AT 1500组（77.1% vs 56.4%，P = 0.010）。AT 1500组中有6.96%（严重出血：3.04%）观察到出血事件，AT 3000组中有6.52%（严重出血，4.35%）观察到出血事件（P = 1.000;严重出血，P = 0.648）。logistic回归分析显示，使用AT 3000（比值比（OR），2.419; P = 0.025）、较高的初始血小板计数（OR，1.054; P = 0.027）和患者年龄（OR，0.977; P = 0.045）与生存率改善显著相关。与AT 1500组相比，AT 3000组在脓毒症相关DIC和AT活性低于40%的患者中显示出生存率和DIC恢复率显著提高，而出血风险不增加。
In a previous report, we demonstrated a favorable trend for supplementation with antithrombin (AT) concentrate at a dosage of 3,000 IU/day over 1,500 IU/day for the treatment of sepsis-associated disseminated intravascular coagulation (DIC) in patients with an AT activity of 70% or less. Since the survival difference did not reach statistical significance, we planned to examine the effects in a larger number of cases with severer disease. We performed a non-randomized multi-institutional survey. In total, 307 septic DIC patients who had AT activity less than 40% and who had undergone AT substitution at a dose of either 1,500 IU/day or 3,000 IU/day for three consecutive days were analyzed. Of these, 259 patients received 1,500 IU/day (AT1500 group) and 48 patients received 3,000 IU/day (AT3000 group). The primary efficacy endpoints were recovery from DIC by day 7 and an all-cause mortality on day 28. Adverse bleeding events were also examined. A logistic regression analysis was conducted by using age, sex, body weight, initial AT activity, DIC score, platelet count, coadministration of heparin, recombinant thrombomodulin, suspected source of infection, surgery, and supplemented AT dose. Supplementation significantly decreased the DIC score in the AT3000 group, leading to the superior resolution of DIC, compared with the results in the AT1500 group (66.7% versus 45.2%, P = 0.007). In addition, the AT3000 group exhibited a better survival than the AT1500 group (77.1% versus 56.4%, P = 0.010). Bleeding events were observed in 6.96% (severe bleeding: 3.04%) in the AT1500 group and 6.52% (severe bleeding, 4.35%) in the AT3000 group (P = 1.000; severe bleeding, P = 0.648). A logistic regression analysis revealed that the use of AT3000 (odds ratio (OR), 2.419; P = 0.025), a higher initial platelet count (OR, 1.054; P = 0.027), and patient age (OR, 0.977; P = 0.045) were significantly correlated with an improved survival. The AT3000 group exhibited significantly improved rates of survival and recovery from DIC without an increased risk of bleeding, compared with the AT1500 group, among the patients with sepsis-associated DIC and an AT activity of less than 40%.
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幸存的败血症运动：严重败血症和化粪池冲击管理的国际指南，2012年。
影响因子：
38.9
作者：
Dellinger RP;Levy MM;Rhodes A;Annane D;Gerlach H;Opal SM;Sevransky JE;Sprung CL;Douglas IS;Jaeschke R;Osborn TM;Nunnally ME;Townsend SR;Reinhart K;Kleinpell RM;Angus DC;Deutschman CS;Machado FR;Rubenfeld GD;Webb S;Beale RJ;Vincent JL;Moreno R;Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
通讯作者：
Surviving Sepsis Campaign Guidelines Committee including The Pediatric Subgroup
DOI：
10.1186/cc13163
发表时间：
2013-12-16
期刊：
Critical care (London, England)
影响因子：
--
作者：
Gando S;Saitoh D;Ishikura H;Ueyama M;Otomo Y;Oda S;Kushimoto S;Tanjoh K;Mayumi T;Ikeda T;Iba T;Eguchi Y;Okamoto K;Ogura H;Koseki K;Sakamoto Y;Takayama Y;Shirai K;Takasu O;Inoue Y;Mashiko K;Tsubota T;Endo S;Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group for the JAAM DIC Antithrombin Trial (JAAMDICAT)
通讯作者：
Japanese Association for Acute Medicine Disseminated Intravascular Coagulation (JAAM DIC) Study Group for the JAAM DIC Antithrombin Trial (JAAMDICAT)
影响因子：
8.8
作者：
Vincent, JL;de Mendonca, A;Blecher, S
通讯作者：
Blecher, S
DOI：
10.1097/01.ta.0000251420.41427.d3
发表时间：
2007-11-01
影响因子：
--
作者：
Iba, Toshiaki;Gando, Satoshi;Shimazaki, Shuji
通讯作者：
Shimazaki, Shuji
影响因子：
15.1
作者：
Iba, Toshiaki;Nakarai, Etsuro;Ohno, Yoichi
通讯作者：
Ohno, Yoichi