Treatment of adult patients with sepsis-induced coagulopathy and purpura fulminans using a plasma-derived protein C concentrate (Ceprotin).
OBJECTIVE
The aim of this study was to document the effects of supplementation with a plasma-derived protein C concentrate in adult patients with infectious purpura fulminans.


METHODS
We report the effect of the administration of a human protein C concentrate (Ceprotin, Baxter, Vienna, Austria) in eight adult patients with purpura fulminans. Five patients received the concentrate as level-adjusted continuous infusion (10 U/kg/h, target protein C activity 100%) and three patients received the concentrate as bolus infusions (100 U/kg every 6 h) in addition to standard sepsis therapy. Heparin, fresh-frozen plasma, antithrombin- and fibrinogen concentrates, low-dose rtPA, and platelet transfusions were given when appropriate.


RESULTS
Six patients had overt disseminated intravascular coagulation: platelets, 19 g/l; fibrinogen, 60 mg/dl; antithrombin, 47%; prothrombin time, 32%; activated partial thromboplastin time (APTT), 88 s; d-dimer, 66 microg/ml; protein C activity, 29% (medians). Five patients had septic shock, six renal failure and four respiratory failure. Patients received between 5000 and 77,000 U of protein C concentrate over 2.5 days (median); the protein C activity increased to 184% (median) and coagulopathy resolved within 3 days in seven of the eight patients. Six patients survived, one died early from fulminant sepsis, and one died after 14 days from candida sepsis.


CONCLUSIONS
Our data suggest that treatment with a plasma-derived protein C zymogen concentrate might be a useful support in adult patients with purpura fulminans.
Schellongowski
Peter
P
Department of Medicine I, Intensive Care Unit 13i2, Medical University of Vienna, Vienna, Austria.
Bauer
Edith
E
Holzinger
Ulrike
U
Staudinger
Thomas
T
Frass
Michael
M
Laczika
Klaus
K
Locker
Gottfried J
GJ
Quehenberger
Peter
P
Rabitsch
Werner
W
Schenk
Peter
P
Knöbl
Paul
P
D000293:Adolescent; D000328:Adult; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006801:Humans; D011695:IgA Vasculitis / Q000188:drug therapy* / Q000209:etiology* / Q000473:pathology; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011486:Protein C / Q000008:administration & dosage / Q000302:isolation & purification / Q000627:therapeutic use*; D018805:Sepsis / Q000150:complications*; D016896:Treatment Outcome
D011486:Protein C