Treatment of adult patients with sepsis-induced coagulopathy and purpura fulminans using a plasma-derived protein C concentrate (Ceprotin).

Abstract

BACKGROUND AND OBJECTIVES:

The aim of this study was to document the effects of supplementation with a plasma-derived protein C concentrate in adult patients with infectious purpura fulminans.

MATERIALS AND METHODS:

We report the effect of the administration of a human protein C concentrate (Ceprotin, Baxter, Vienna, Austria) in eight adult patients with purpura fulminans. Five patients received the concentrate as level-adjusted continuous infusion (10 U/kg/h, target protein C activity 100%) and three patients received the concentrate as bolus infusions (100 U/kg every 6 h) in addition to standard sepsis therapy. Heparin, fresh-frozen plasma, antithrombin- and fibrinogen concentrates, low-dose rtPA, and platelet transfusions were given when appropriate.

RESULTS:

Six patients had overt disseminated intravascular coagulation: platelets, 19 g/l; fibrinogen, 60 mg/dl; antithrombin, 47%; prothrombin time, 32%; activated partial thromboplastin time (APTT), 88 s; d-dimer, 66 microg/ml; protein C activity, 29% (medians). Five patients had septic shock, six renal failure and four respiratory failure. Patients received between 5000 and 77,000 U of protein C concentrate over 2.5 days (median); the protein C activity increased to 184% (median) and coagulopathy resolved within 3 days in seven of the eight patients. Six patients survived, one died early from fulminant sepsis, and one died after 14 days from candida sepsis.

CONCLUSIONS:

Our data suggest that treatment with a plasma-derived protein C zymogen concentrate might be a useful support in adult patients with purpura fulminans.

• Authors: Peter Schellongowski, Edith Bauer, Ulrike Holzinger, Thomas Staudinger, Michael Frass, Klaus Laczika, Gottfried J Locker, Peter Quehenberger, Werner Rabitsch, Peter Schenk, Paul Knöbl
• Journal: Vox sanguinis (Vox Sang) Vol. 90 Issue 4 Pg. 294-301 (May 2006) ISSN: 0042-9007 [Print] England
• PMID: 16635072 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Protein C

Topics

• Adolescent
• Adult
• Disseminated Intravascular Coagulation (drug therapy, etiology)
• Female
• Humans
• IgA Vasculitis (drug therapy, etiology, pathology)
• Infusions, Intravenous
• Male
• Middle Aged
• Protein C (administration & dosage, isolation & purification, therapeutic use)
• Sepsis (complications)
• Treatment Outcome