title: Clinical features and outcomes of 35 disseminated intravascular coagulation cases treated with recombinant human soluble thrombomodulin at a single institution.
abstract: Disseminated intravascular coagulation (DIC) is a clinical entity with high mortality and is characterized by multiple organ failure caused by activation of systemic intravascular coagulation. Although a standard treatment for DIC has not been established owing to the absence of randomized controlled trials, recent reports have indicated that recombinant human soluble thrombomodulin (rTM) is effective against DIC. To elucidate the clinical characteristics and outcomes of DIC, we retrospectively analyzed 35 DIC patients treated with rTM at our institution over a 2-year period (infectious disease: 21 cases; hematological disease: 14 cases). Diagnosis of DIC was based on the diagnostic criteria for DIC of the Japanese Ministry of Health and Welfare. In addition to the treatment of underlying diseases, we administered rTM for 6 consecutive days. Twenty-one (60.0%) of the DIC patients attained resolution of DIC at 7 days after administration (infectious disease: 61.9%; hematological disease: 57.1%). Furthermore, 7 of the remaining 14 DIC patients (who did not attain resolution at 7 days) attained resolution at an average of 12.1 days. Consequently, 28 (80.0%) of the 35 patients were alive with resolution of DIC after a 28-day observation period (infectious disease: 76.2%; hematological disease: 85.7%). Among them, for 7 (70%) of the 10 DIC patients with severe life-threatening bleeding symptoms without hemorrhagic shock, treatment with heparin was contraindicated; these patients were successfully treated with rTM without the progression of hemorrhage. In the majority of DIC patients, rTM administration may be an effective, safe, and feasible therapeutic modality producing a good outcome.
authors: Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan. kawanoriaki@yahoo.co.jp
authors: Noriaki
authors: N
authors: Kawano
authors: Shuro
authors: S
authors: Yoshida
authors: Nobuyuki
authors: N
authors: Ono
authors: Daisuke
authors: D
authors: Himeji
authors: Yuri
authors: Y
authors: Nagahiro
authors: Sayaka Kawano
authors: Kiyoshi
authors: K
authors: Yamashita
authors: Naoko
authors: N
authors: Ikeda
authors: Shigehiro
authors: S
authors: Uezono
authors: Hidenobu
authors: H
authors: Ochiai
authors: Fumiko
authors: F
authors: Kawano
authors: Ikuo
authors: I
authors: Kikuchi
authors: Fumihiko
authors: F
authors: Ishikawa
authors: Kazuya
authors: K
authors: Shimoda
authors: Akira
authors: A
authors: Ueda
authors: Koichi
authors: K
authors: Akashi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018180:Thrombomodulin