Toshiaki Iba1, Satoshi Gando2, Daizoh Saitoh3, Hideo Wada4, Marcello Di Nisio5, Jecko Thachil6. 1. Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Japan. Electronic address: toshiiba@cf6.so-net.ne.jp. 2. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Japan. Electronic address: gando@med.hokudai.ac.jp. 3. Division of Traumatology, National Defense Medical College Research Institute, National Defense Medical College, Japan. Electronic address: ds0711@ndmc.ac.jp. 4. Department of Molecular Laboratory Medicine, Mie University Graduate School of Medicine, Japan. Electronic address: wadahide@clin.medic.mie-u.ac.jp. 5. Department of Medical, Oral and Biotechnological Sciences, University G D'Annunzio of Chieti-Pescara, Italy. Electronic address: mdinisio@unich.it. 6. Department of Haematology, Manchester Royal Infirmary, United Kingdom. Electronic address: Jecko.thachil@cmft.nhs.uk.
Abstract
INTRODUCTION: Although antithrombin 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 (1500IU/day or 3000IU/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>7days 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 increased risk of bleeding in patients with sepsis-associated DIC.
INTRODUCTION: Although antithrombin 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 (1500IU/day or 3000IU/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>7days 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 increased risk of bleeding in patients with sepsis-associated DIC.