Recent Change in Treatment of Disseminated Intravascular Coagulation in Japan: An Epidemiological Study Based on a National Administrative Database.
This study investigated the time trends and hospital factors affecting the use of drugs for infectious disease-associated disseminated intravascular coagulation (DIC) based on a national administrative database. A total of 14 324 patients with infectious disease-associated DIC were referred to 1041 hospitals from 2010 to 2012 in Japan. Patients' data were collected from the administrative database to determine time trends and hospital factors affecting the use of drugs for DIC. Three study periods were established, namely, the fiscal years 2010 (n = 3308), 2011 (n = 5403), and 2012 (n = 5613). The use of antithrombin, heparin, protease inhibitors, and recombinant human soluble thrombomodulin (rhs-TM) for DIC was evaluated. The frequency of use of antithrombin, heparin, and protease inhibitors decreased while that of rhs-TM significantly increased from 2010 to 2012 in Japan (25.1% in 2010, 43.1% in 2011, and 56.8% in 2012; P < .001, respectively). Logistic regression showed that the study period was associated with the use of rhs-TM in patients with DIC. The odds ratio (OR) for 2011 was 2.34 (95% confidence interval [CI], 2.12-2.58; P < .001) whereas that for 2012 was 4.34 (95% CI, 3.94-4.79; P < .001). A large hospital size was the most significant factor associated with the use of rhs-TM in patients with DIC (OR, 3.14; 95% CI, 2.68-3.66; P < .001). The use of rhs-TM has dramatically increased. A large hospital size was significantly associated with the increased use of rhs-TM in patients with DIC from 2010 to 2012 in Japan.
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan amurata@med.uoeh-u.ac.jp.
Atsuhiko
A
Murata
Department of Surgery, Yahata Municipal Hospital, Kitakyushu, Fukuoka, Japan.
Kohji
K
Okamoto
Department of Emergency Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Toshihiko
T
Mayumi
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Keiji
K
Muramatsu
Department of Preventive Medicine and Community Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
Shinya
S
Matsuda
D000368:Aged; D000369:Aged, 80 and over; D000991:Antithrombins / Q000008:administration & dosage*; D016208:Databases, Factual; D018572:Disease-Free Survival; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000008:administration & dosage*; D012307:Risk Factors; D015996:Survival Rate; D018180:Thrombomodulin / Q000008:administration & dosage*
D000991:Antithrombins; D011480:Protease Inhibitors; C546931:THBD protein, human; D018180:Thrombomodulin; D006493:Heparin
administrative database; disseminated intravascular coagulation; hospital factors; recombinant human soluble thrombomodulin; time trend