title: Comparison of recombinant human thrombomodulin and gabexate mesylate for treatment of disseminated intravascular coagulation (DIC) with sepsis following emergent gastrointestinal surgery: a retrospective study.
abstract: OBJECTIVE
  Recombinant thrombomodulin (rTM) has been available in Japan since 2008, but there is concern about its association with postoperative hemorrhage. The efficacy and safety of rTM were examined in patients with disseminated intravascular coagulation (DIC) caused by a septic condition after gastrointestinal surgery.
  
  
  METHODS
  Forty-two patients were emergently admitted to the intensive care unit after emergent gastrointestinal surgery in Kyushu University Hospital from May 2008 to April 2013. Of these patients, 22 had DIC (defined as an acute DIC score ≥ 4). All but three patients received treatment with gabexate mesylate (GM) (n = 9) or rTM (n = 10). The causes of sepsis were peritonitis with colorectal perforation, anastomotic leakage, and intestinal necrosis. Acute DIC score, sepsis-related organ failure assessment score, platelet count, and a variety of biochemical parameters were compared between rTM and GM recipients after treatment administration.
  
  
  RESULTS
  There were no significant differences between the groups for any parameter except C-reactive protein levels. The CRP level tended to be lower in the rTM group than in the GM group. Acute DIC score in the rTM group resolved significantly earlier than that in the GM group. No patient stopped the administration of rTM because of postoperative bleeding.
  
  
  CONCLUSIONS
  rTM may be an effective therapeutic drug for the treatment of septic patients with DIC following emergent gastrointestinal surgery.
authors.affiliation: Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. a_tom411@yahoo.co.jp.|Emergency and Critical Care Center, Kyushu University, Fukuoka, Japan. a_tom411@yahoo.co.jp.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. a_tom411@yahoo.co.jp.
authors.forename: T
authors.initials: T
authors.lastname: Akahoshi
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Sugimori
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Kaku
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Tokuda
authors.affiliation: Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nagata
authors.affiliation: Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Noda
authors.affiliation: Emergency and Critical Care Center, Kyushu University, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Morita
authors.affiliation: Department of Disaster and Emergency Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Hashizume
authors.affiliation: Emergency and Critical Care Center, Kyushu University, Fukuoka, Japan.|Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D003422:Critical Care; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy*; D004638:Emergency Treatment; D005260:Female; D016670:Gabexate / Q000627:therapeutic use*; D005767:Gastrointestinal Diseases / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D012189:Retrospective Studies; D018805:Sepsis / Q000150:complications* / Q000188:drug therapy*; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D011994:Recombinant Proteins; C546931:THBD protein, human; D018180:Thrombomodulin; D016670:Gabexate
keywords: DIC; Gastrointestinal surgery; Panperitonitis; Sepsis; rTM