title: Use of antithrombin and thrombomodulin in the management of disseminated intravascular coagulation in patients with acute cholangitis.
abstract: OBJECTIVE
  To evaluate the usefulness and safety of treating disseminated intravascular coagulation (DIC) complicating cholangitis primarily with antithrombin (AT) and thrombomodulin (rTM).
  
  
  METHODS
  A DIC treatment algorithm was determined on the basis of plasma AT III levels at the time of DIC diagnosis and DIC score changes on treatment day 3. Laboratory data and DIC scores were assessed prospectively at 2-day intervals.
  
  
  RESULTS
  DIC reversal rates >75% were attained on day 7. In the DIC reversal group, statistically significant differences from baseline were observed in interleukin-6 and C-reactive protein levels within 5 days. Patients with no DIC score improvements after treatment with AT alone experienced slow improvement on a subsequent combination therapy with rTM. Although a subgroup with biliary drainage showed greater improvement in DIC scores than did the nondrainage subgroup, the mean DIC score showed improvement even in the nondrainage subgroup alone. Gastric cancer bleeding that was treated conservatively occurred in one patient. As for day 28 outcomes, three patients died from concurrent malignancies.
  
  
  CONCLUSIONS
  Although this algorithm was found to be useful and safe for DIC patients with cholangitis, it may be better to administer rTM and AT simultaneously from day 1 if the plasma AT III level is less than 70%.
authors.affiliation: Department of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kawasaki, Japan.
authors.forename: Kazunari
authors.initials: K
authors.lastname: Nakahara
authors.forename: Chiaki
authors.initials: C
authors.lastname: Okuse
authors.forename: Seitaro
authors.initials: S
authors.lastname: Adachi
authors.forename: Keigo
authors.initials: K
authors.lastname: Suetani
authors.forename: Sarika
authors.initials: S
authors.lastname: Kitagawa
authors.forename: Miki
authors.initials: M
authors.lastname: Okano
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Michikawa
authors.forename: Rei
authors.initials: R
authors.lastname: Takagi
authors.forename: Ryuta
authors.initials: R
authors.lastname: Shigefuku
authors.forename: Fumio
authors.initials: F
authors.lastname: Itoh
keywords: Antithrombins; Cholangitis; Disseminated intravascular coagulation; Thrombomodulin