title: Efficacy and Bleeding Risk of Antithrombin Supplementation in Patients With Septic Disseminated Intravascular Coagulation: A Third Survey.
abstract: BACKGROUND
  Although recent studies have reported the efficacy of antithrombin (AT) supplementation for sepsis-associated disseminated intravascular coagulation (DIC), the factors that influence AT's effect have not been sufficiently studied. The purpose of this survey was to identify factors that modulate the effects and the adverse effects of AT.
  
  
  METHODS
  We performed a multi-institutional survey. The data from 159 patients with septic DIC with AT ≤70% and who had undergone AT supplementation were analyzed. The patients' demographic characteristics, including the infection site, baseline sepsis-related organ failure assessment (SOFA) score, baseline DIC score, and baseline AT activity, were analyzed in relation to the 28-day mortality. Bleeding-related adverse events were also examined.
  
  
  RESULTS
  Overall, 116 patients survived and 43 did not (28-day mortality: 27.0%). A logistic regression analysis revealed that the baseline SOFA score (odds ratio [OR]: 0.816, P = .001), coadministration of recombinant thrombomodulin (rTM; OR: 3.989, P = .006), and respiratory tract infection (OR: 0.129, P = .000) were significantly associated with the survival. Survivors exhibited a higher peak AT activity than nonsurvivors (85.1% vs 65.0%, P = .027). Bleeding events were observed in 4.13% (major bleeding: 1.65%) of the patients, and the coadministration of rTM did not increase the risk of bleeding (with rTM: 4.11% vs without rTM: 4.17%). Heparin was concomitantly used in 22 (18.2%) cases, and its use nonsignificantly increased the bleeding risk (with heparins: 9.09% vs without heparins: 3.03%; P = .224).
  
  
  CONCLUSIONS
  The coadministration of rTM may improve survival without increasing the risk of bleeding in patients with sepsis-associated DIC treated with AT.
authors.affiliation: 1 Department of Emergency and Disaster Medicine, Juntendo University Graduate School of Medicine, Bunkyō, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Iba
authors.affiliation: 2 Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Gando
authors.affiliation: 3 Division of Traumatology, National Defense Medical College Research Institute, National Defense Medical College, Tokorozawa, Japan.
authors.forename: Daizoh
authors.initials: D
authors.lastname: Saitoh
authors.affiliation: 4 Division of Critical Care Medicine, Tokyo Medical University Hachioji Medical Center, Hachioji, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Ikeda
authors.affiliation: 5 Emergency Medical Center, Fujisawa City Hospital, Fujisawa, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Anan
authors.affiliation: 6 Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
authors.affiliation: 7 Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Kimitsu, Japan.
authors.forename: Nobuya
authors.initials: N
authors.lastname: Kitamura
authors.affiliation: 8 Emergency Medical Center, Chuno Kosei Hospital, Seki, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Mori
authors.affiliation: 9 Department of Emergency and Critical Care Medicine, Hyogo College of Medicine, Kobe, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kotani
authors.affiliation: 10 Department of Emergency, Disaster and Critical Care Medicine, University of Kagawa, Takamatsu, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kuroda
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000188:drug therapy* / Q000401:mortality; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced / Q000401:mortality; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000097:blood / Q000188:drug therapy / Q000401:mortality; D011358:Product Surveillance, Postmarketing; D018805:Sepsis / Q000097:blood / Q000188:drug therapy* / Q000401:mortality
chemical_list: D005343:Fibrinolytic Agents
keywords: anticoagulant; antithrombin; disseminated intravascular coagulation; sepsis; thrombomodulin