Antithrombin supplementation and risk of bleeding in patients with sepsis-associated disseminated intravascular coagulation
Antithrombin supplementation and risk of bleeding in patients with sepsis-associated disseminated intravascular coagulation
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DOI：
10.1016/j.thromres.2016.07.016
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发表时间：
2016-09-01
影响因子：
7.5
通讯作者：
Thachil, Jecko
中科院分区：
文献类型：
--
作者：
Iba, Toshiaki;Gando, Satoshi;Thachil, Jecko
简介：虽然在日本，anuthrombin常用于治疗脓毒症相关的弥散性血管内凝血（DIC），但影响出血并发症发生率的因素尚未得到充分研究。本次调查的目的是确定在接受抗凝血酶治疗 DIC 的患者中预测临床相关出血的因素。方法：我们分析了 1026 名脓毒症相关 DIC 患者的数据，这些患者的基线抗凝血酶活性为 70%，这些患者连续三天接受两种剂量（1500 IU/天或 3000 IU/天）的抗凝血酶补充。分析患者的人口统计学特征、治疗前后的参数以及联合使用的抗凝药物与出血事件的关系。结果：总体而言，55 名患者（5.36%）经历了出血事件（大出血：1.75%）。 Logistic 回归分析显示，持续 DIC > 7 天与出血显着相关（比值比：2.761，P = 0.001）。相反，较高剂量的抗凝血酶或联合使用重组血栓调节蛋白或肝素与出血事件无关。结论：较高剂量的抗凝血酶或同时使用其他抗凝剂与出血事件无关。另一方面，持续超过一周的持续 DIC 与脓毒症相关 DIC 患者出血风险增加相关。 (C) 2016 年由爱思唯尔有限公司出版。
Introduction: Although anuthrombin is commonly used for the treatment of sepsis-associated disseminated intravascular coagulation (DIC) in japan, the factors influencing the incidence of bleeding complications have not been sufficiently studied. The purpose of this survey was to identify the factors that predict clinically relevant bleeding in patients receiving antithrombin for DIC.Methods: We analyzed data from 1026 sepsis-associated DIC patients with a baseline antithrombin activity 70% who underwent antithrombin supplementation at two dosages (1500 IU/day or 3000 IU/day) for three consecutive days. The patients demographic characteristics, parameters before and after the treatment, and co-administered anticoagulants were analyzed in relation to the bleeding events.Results: Overall, 55 patients (5.36%) experienced bleeding events (major bleeding: 1.75%). Logistic regression analysis revealed that sustained DIC > 7 days was significantly associated with bleeding (odds ratio: 2.761, P = 0.001). In contrast, the higher dose of antithrombin or the co-administration of recombinant thrombomodulin or heparins were not associated with bleeding events.Conclusion: A higher dose of antithrombin or the concomitant use of other anticoagulants were not associated with bleeding events. On the other hand, sustained DIC lasting more than one week was associated with an increase risk of bleeding in patients with sepsis-associated DIC. (C) 2016 Published by Elsevier Ltd.