Early suspension of activated protein C treatment in septic patients after shock reversal.
OBJECTIVE
After observing that the interruption of activated protein C (aPC) treatment after septic shock reversal was not associated with any deleterious effect, we started to suspend the treatment whenever vasopressors were no longer required. We present a report of our data.


METHODS
We studied retrospectively a 3-year septic shock database that included 157 patients from a surgical ICU in a university hospital. aPC was considered to be indicated in 111 cases. We analysed data from 20 surgical patients with septic shock in whom aPC treatment was suspended before 96 h due to noradrenaline withdrawal (NA-). These patients were compared with a group of patients in whom aPC was suspended for coagulation disorders or surgical reasons while still receiving vasopressor treatment (NA+, n = 11), with patients not treated with aPC, although presenting criteria for its use (aPC-, n = 31) and with patients receiving the standard protocol for 96 h (aPC+, n = 49).


RESULTS
No differences in age, sex, severity scores or source of infection were found between groups. Noradrenaline was not required by any NA- patient within 24 h after aPC withdrawal. A statistically nonsignificant trend to a lower mortality was observed in the NA- patients [4/20 (20%) vs. 5/11 (46%) in NA+, 18/31 (58.1%) in aPC- and 22/49 (45%) in aPC+ patients, P = 0.066].


CONCLUSIONS
The use of aPC should be considered in septic shock, but its suspension after shock reversal in this small series of patients was not associated with any deleterious effect.
Pestaña
David
D
Servicio de Anestesia-Reanimación, Residencia General, Hospital Universitario La Paz, Paseo de la Castellana 261, Madrid, Spain. dpestana.hulp@salud.madrid.org
Ramos
Raquel
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage*; D011486:Protein C / Q000008:administration & dosage*; D012189:Retrospective Studies; D012772:Shock, Septic / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage*
D000925:Anticoagulants; D011486:Protein C; D014662:Vasoconstrictor Agents; D009638:Norepinephrine