title: A retrospective comparative study of recombinant human thrombomodulin and gabexate mesilate in sepsis-induced disseminated intravascular coagulation patients.
abstract: The novel biological agent recombinant human thrombomodulin (rhTM) has been used clinically in Japan to treat disseminated intravascular coagulation (DIC) since 2008. Previous studies have shown the efficacy of rhTM versus heparin therapy or non-rhTM therapy. We retrospectively evaluated and compared the efficacies of rhTM and gabexate mesilate (GM) in patients diagnosed with sepsis-induced DIC. From September 2010 to October 2012, patients with sepsis-induced DIC who were treated with rhTM (n = 13) or GM (n = 10) at Nagasaki Municipal Hospital were extracted. Patients receiving other anticoagulants in combination were excluded. Clinical information, laboratory data, Sequential Organ Failure Assessment (SOFA) scores, and DIC scores were obtained from the medical records. Mortality at days 7 and 30 after DIC diagnosis and changes in laboratory data and SOFA scores from days 1-7 were evaluated. The groups' clinical characteristics did not differ, except for the relatively higher C-reactive protein (CRP) levels in the rhTM group (P = 0.0508). The survival rates of the rhTM and GM groups on days 7 and 30 were 92.3%, 69.2% and 80%, 70%, respectively, both group indicated similar mortality. However, on day 7, the platelet counts, SOFA scores, and CRP levels significantly improved in the rhTM group; the platelet counts and SOFA scores did not improve significantly in the GM group. The platelet counts of the rhTM group significantly improved compared to the GM group (P = 0.004). Recombinant human thrombomodulin might be more effective for sepsis-induced DIC than GM.
authors.affiliation: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan; Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. Electronic address: takahiro-takazono@nagasaki-u.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Takazono
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Imamura
authors.affiliation: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
authors.forename: Sumako
authors.initials: S
authors.lastname: Yoshioka
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Taiga
authors.initials: T
authors.lastname: Miyazaki
authors.affiliation: Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Izumikawa
authors.affiliation: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
authors.forename: Toyomitsu
authors.initials: T
authors.lastname: Sawai
authors.affiliation: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
authors.forename: Nobuko
authors.initials: N
authors.lastname: Matsuo
authors.affiliation: Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan.
authors.forename: Katsunori
authors.initials: K
authors.lastname: Yanagihara
authors.affiliation: Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
authors.forename: Naofumi
authors.initials: N
authors.lastname: Suyama
authors.affiliation: Department of Respiratory Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Kohno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000032:analysis; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D016670:Gabexate / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D010976:Platelet Count; D011994:Recombinant Proteins / Q000627:therapeutic use*; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000453:epidemiology; D016019:Survival Analysis; D018180:Thrombomodulin / Q000627:therapeutic use*
chemical_list: D011994:Recombinant Proteins; C546931:THBD protein, human; D018180:Thrombomodulin; D016670:Gabexate; D002097:C-Reactive Protein
keywords: Disseminated intravascular coagulation; Gabexate mesilate; Recombinant human thrombomodulin; Retrospective study; Sepsis