Is protease inhibitor a choice for the treatment of pre- or mild disseminated intravascular coagulation?
OBJECTIVE
To investigate the effect of a protease inhibitor, gabexate mesylate, on patients with pre- or mild disseminated intravascular coagulation (DIC) in comparison with a control group receiving no anticoagulation therapy.


METHODS
Prospective, randomized, controlled study.


METHODS
General intensive care unit at a general hospital.


METHODS
Adult patients (40) with a DIC score between 6 and 8 (pre- or mild DIC).


METHODS
In 20 patients, gabexate mesylate (2 mg/kg/hr) was administered as 2 mL/hr in saline (treated group) and in another 20 patients, saline (2 mL/hr; control group) was administered during the study (7 days).


RESULTS
The following variables were determined at the time of admission to the intensive care unit before treatment and 1, 3, 5, and 7 days thereafter: platelet count, antithrombin III activity, serum or plasma concentrations of fibrinogen, fibrin degradation product, D-dimer, fibrin monomer, thrombin-antithrombin III complex, and plasmin-plasmin inhibitor complex, prothrombin time ratio, and DIC score. Two patients in the treated group and four in the control group were excluded from the study because they died during the study; therefore, 34 patients were analyzed. The measured variables of coagulation and fibrinolysis were not significantly different between the two groups, except for the D-dimer on day 3 (the treated group showed a higher concentration). D-dimer concentration and DIC score went down more quickly in the control group than the treated group, but not significantly. The mortality rate at 1 month was 40% (8 of 20) in the treated group and 35% (7 of 20) in the control group, without any differences between the two groups.


CONCLUSIONS
In a limited number of patients (n = 34), gabexate mesylate (2 mg/kg/hr) could not inhibit coagulation or fibrinolysis and gabexate mesylate could not improve the DIC score or mortality rate in pre- or mild DIC.
Nishiyama
T
T
Department of Anesthesiology, The University of Tokyo, Japan.
Matsukawa
T
T
Hanaoka
K
K
D000328:Adult; D000368:Aged; D001780:Blood Coagulation Tests; D003422:Critical Care; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects; D016670:Gabexate / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015842:Serine Proteinase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate
D015842:Serine Proteinase Inhibitors; D016670:Gabexate