Anticoagulation Therapy Using rh-Thrombomodulin and/or Antithrombin III Agent is Associated With Reduction in in-Hospital Mortality in Septic Disseminated Intravascular Coagulation: A Nationwide Registry Study
Anticoagulation Therapy Using rh-Thrombomodulin and/or Antithrombin III Agent is Associated With Reduction in in-Hospital Mortality in Septic Disseminated Intravascular Coagulation: A Nationwide Registry Study
复制标题
使用 rh-血栓调节蛋白和/或抗凝血酶 III 药物的抗凝治疗与降低脓毒症播散性血管内凝血的院内死亡率相关：一项全国登记研究
作者：
Keiko Tanaka;J. Takeba;Hironori Matsumoto;M. Ohshita;Suguru Annen;Naoki Moriyama;Yuki Nakabayashi;M. Aibiki
摘要 我们分析了全国脓毒症登记数据库，以检查抗凝治疗的效果，特别是使用 rh-血栓调节蛋白 (rh-TM) 和/或抗凝血酶 (AT) III 药物，对脓毒症弥散性血管内凝血 (DIC) 患者的效果。在排除后纳入的 3,193 名患者中，我们使用 Cox 比例风险模型调查了其与院内死亡率的关联。 DIC 的诊断采用日本急性医学会 (JAAM) 和国际血栓与止血学会 (ISTH) 标准。为了分析rh-TM和/或AT III的单独治疗效果，我们排除了接受所有可用抗凝治疗（rh-TM和/或AT III加“其他抗凝剂”：蛋白酶抑制剂和肝素/类肝素）治疗的345名患者的数据。 DIC 标准群体如下：JAAM DIC，n = 1,891 和 ISTH DIC（公开 DIC），n = 1,002。脓毒症DIC患者分为3组：第1组，DIC不进行抗凝治疗；第2组，接受rh-TM和/或AT III；第 3 组仅接受“其他抗凝剂”。在 JAAM DIC 患者中，与第 1 组相比，第 2 组并未显示出与院内死亡风险降低的独立相关性（风险比 [HR]：0.86；95% 置信区间 [CI]：0.73–1.01]）。然而，在 ISTH DIC 患者中，第 2 组与院内死亡风险呈负相关（HR 0.74；95% CI： 0.60–0.92) 作为 与第 1 组相比，但第 3 组的情况并非如此（HR 0.73；95% CI：0.47–1.14）。目前的结果支持了先前关于抗凝治疗对脓毒症 DIC 有益的发现，也扩大了使用 rh-TM 和/或 AT 药物治疗脓毒症明显 DIC 的重要性。
ABSTRACT We analyzed the Nationwide Registry database on sepsis to examine the effects of an anticoagulation therapy, especially with rh-thrombomodulin (rh-TM) and/or antithrombin (AT) III agent, in septic disseminated intravascular coagulation (DIC) patients. In 3,193 patients enrolled after the exclusion, we investigated the association with in-hospital mortality using Cox proportional hazards models. DIC was diagnosed using the Japanese Association of Acute Medicine (JAAM) and the International Society of Thrombosis and Hemostasis (ISTH) criteria. To analyze the separate treatment effects of rh-TM and/or AT III, we excluded the data of 345 patients treated with all available anticoagulation treatments (rh-TM and/or AT III plus “other anticoagulants”: protease inhibitors and heparin/heparinoids). The DIC criterion populations were as follows: JAAM DICs, n = 1,891 and ISTH DICs (overt DIC), n = 1,002. Septic DIC patients were divided into 3 groups: Group 1, no anticoagulation therapy for DIC; Group 2, received rh-TM and/or AT III; and Group 3, received only “other anticoagulants.” In JAAM DIC patients, Group 2 did not show an independent association with a reduced risk of in-hospital mortality (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.73–1.01]) as compared with Group 1. However, in ISTH DIC patients, Group 2 showed an inverse association with the risk of in-hospital mortality (HR 0.74; 95% CI: 0.60–0.92) as compared with Group 1, but the same was not true for Group 3 (HR 0.73; 95% CI: 0.47–1.14). The present results support previous findings of the beneficial effects of anticoagulation therapies in septic DIC, also expands the importance of using rh-TM and/or AT agent for septic overt DIC.