Effects of recombinant human soluble thrombomodulin treatment for disseminated intravascular coagulation at a single institution--an analysis of 62 cases caused by infectious diseases and 30 cases caused by hematological diseases.
OBJECTIVE
Disseminated intravascular coagulation (DIC) is a clinical condition with high mortality that is characterized by the systemic activation of coagulation pathways resulting in multiple organ failure. Although no standard treatment for DIC has been established, recent reports have indicated that recombinant human soluble thrombomodulin (rTM) is effective against DIC.


METHODS
To elucidate the clinical characteristics and outcomes of DIC, we retrospectively analyzed 92 DIC patients who were treated with rTM at Miyazaki Prefectural Hospital over a 4-year period (62 patients had infectious diseases and 30 patients had hematological diseases). A diagnosis of DIC was made based on the diagnostic criteria of the Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW) for infectious diseases and hematological diseases, respectively. In addition to treating the underlying disease, rTM was administered for six consecutive days.


RESULTS
In this study, 49 of the 92 DIC patients (53.3%) experienced resolution of DIC seven days after administration (46.8% patients with infectious disease and 66.7% with hematological disease). A higher survival rate was observed after a 28-day observation period in 69 of the 92 patients (75.0%) (72.6% of the patients with infectious disease and 80.0% of the patients with hematological disease). A lower DIC score at the initiation of rTM treatment was closely related to a higher rate of resolution of DIC.


CONCLUSIONS
Our findings indicate that rTM therapy is an effective, safe and feasible treatment for DIC patients. Furthermore, making an accurate and early diagnosis of DIC and providing subsequent immediate treatment with rTM may improve the resolution of DIC.
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan.
Noriaki
N
Kawano
Akira
A
Tasaki
Takuro
T
Kuriyama
Yoshihiro
Y
Tahara
Shuro
S
Yoshida
Nobuyuki
N
Ono
Daisuke
D
Himeji
Kiyoshi
K
Yamashita
Yoshihiro
Y
Shibata
Toshiyuki
T
Goto
Tomohiro
T
Inoue
Naoko
N
Yokota-Ikeda
Shigehiro
S
Uezono
Akihiko
A
Yuge
Toshihiro
T
Nishiguchi
Tamahiro
T
Kinjo
Yasuhiro
Y
Ogura
Kiichiro
K
Beppu
Yuji
Y
Ueda
Mariko
M
Kinoshita
Hiroshi
H
Moritake
Kazuya
K
Shimoda
Hidenobu
H
Ochiai
Akira
A
Ueda
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003141:Communicable Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D004211:Disseminated Intravascular Coagulation / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D006402:Hematologic Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
D011994:Recombinant Proteins; C546931:THBD protein, human; D018180:Thrombomodulin