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Recombinant human soluble thrombomodulin and mortality in sepsis-induced disseminated intravascular coagulation : a multicentre retrospective study

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Please use this identifier to cite or link to this item:http://hdl.handle.net/2115/65839

Title: Recombinant human soluble thrombomodulin and mortality in sepsis-induced disseminated intravascular coagulation : a multicentre retrospective study
Other Titles: rhTM and mortality in sepsis-induced DIC
Authors: Hayakawa, Mineji Browse this author →KAKEN DB
Yamakawa, Kazuma Browse this author
Saito, Shinjiro Browse this author
Uchino, Shigehiko Browse this author
Kudo, Daisuke Browse this author →KAKEN DB
Iizuka, Yusuke Browse this author
Sanui, Masamitsu Browse this author
Takimoto, Kohei Browse this author
Mayumi, Toshihiko Browse this author
Ono, Kota Browse this author
Japan Septic Disseminated Intravascular Coagulation (JSEPTIC DIC) study group Browse this author
Keywords: sepsis
disseminated intravascular coagulation
coagulation abnormality
mortality
thrombomodulin
Issue Date: Jun-2016
Publisher: Schattauer Publishers
Journal Title: Thrombosis and Haemostasis
Volume: 115
Issue: 6
Start Page: 1157
End Page: 1166
Publisher DOI: 10.1160/TH15-12-0987
PMID: 26939575
Abstract: Recombinant human soluble thrombomodulin (rhTM) is a novel class of anticoagulants for treating disseminated intravascular coagulation (DIC). Although rhTM is widely used in clinical settings throughout Japan, there is limited clinical evidence supporting the use of rhTM in patients with sepsis-induced DIC. Furthermore, rhTM is not approved for DIC treatment in other countries. This study aimed to clarify the survival benefits of rhTM administration in critically ill patients. Data from 3,195 consecutive adult patients who were admitted to 42 intensive care units for the treatment of severe sepsis or septic shock between January 2011 and December 2013 were retrospectively analysed, and 1,784 patients were diagnosed with DIC based on the scoring algorithm from the Japanese Association for Acute Medicine DIC (n = 645, rhTM group; n = 1,139, control group). Propensity score matching created 452 matched pairs, and logistic regression analysis revealed a significant association between rhTM administration and lower in-hospital all-cause mortality in the propensity score-matched groups (odds ratio, 0.757; 95% CI, 0.574-0.999, P = 0.049). Inverse probability of treatment weighted and quintile-stratified analyses also revealed significant associations between rhTM administration and lower in-hospital all-cause mortality. Survival time in the propensity score-matched rhTM group was significantly longer than that in the propensity score-matched control group (hazard ratio, 0.781; 95% CI, 0.624-0.977, P = 0.03). Bleeding complications were not more frequent in the rhTM groups. In conclusion, this study demonstrated that rhTM administration is associated with reduced in-hospital all-cause mortality among patients with sepsis-induced DIC.
Rights: This article is not an exact copy of the original published article in Thrombosis and Haemostasis. The definitive publisher-authenticated version of Thromb Haemost 2016; 115: 1157–1166 is available online at: http://dx.doi.org/10.1160/TH15-12-0987
Type: article (author version)
URI: http://hdl.handle.net/2115/65839
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 早川 峰司

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