Supplemental dose of antithrombin use in disseminated intravascular coagulation patients after abdominal sepsis.

Abstract

The effectiveness of supplemental dose antithrombin administration (1,500 to 3,000 IU/ day) for patients with sepsis-associated disseminated intravascular coagulation (DIC), especially sepsis due to abdominal origin, remains uncertain. This was a retrospective cohort study of patients with mechanically ventilated septic shock and DIC after emergency surgery for perforation of the lower intestinal tract using a nationwide administrative database, Japanese Diagnosis Procedure Combination inpatient database. A total of 2,164 patients treated at 612 hospitals during the 33-month study period between 2010 and 2013 were divided into an antithrombin group (n=1,021) and a control group (n=1,143), from which 518 propensity score-matched pairs were generated. Although there was no significant 28-day mortality difference between the two groups in the unmatched groups (control vs antithrombin: 25.7 vs 22.9 %; difference, 2.8 %; 95 % confidence interval [CI], -0.8-6.4), a significant difference existed between the two groups in propensity-score weighted groups (26.3 vs 21.7 %; difference, 4.6 %; 95 % CI, 2.0-7.1) and propensity-score matched groups (27.6 vs 19.9 %; difference, 7.7 %; 95 % CI, 2.5-12.9). Logistic regression analyses showed a significant association between antithrombin use and lower 28-day mortality in propensity-matched groups (odds ratio, 0.65; 95 % CI, 0.49-0.87). Analysis using the hospital antithrombin-prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 6.5 % (95 % CI, 0.05-13.0) reduction in 28-day mortality. Supplemental dose of antithrombin administration may be associated with reduced 28-day mortality in sepsis-associated DIC patients after emergency laparotomy for intestinal perforation.

• Authors: Takashi Tagami, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
• Journal: Thrombosis and haemostasis (Thromb Haemost) Vol. 114 Issue 3 Pg. 537-45 (Aug 31 2015) ISSN: 2567-689X [Electronic] Germany
• PMID: 25948492 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)

Chemical References

• Antithrombins

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antithrombins (administration & dosage, adverse effects)
• Chi-Square Distribution
• Databases, Factual
• Disseminated Intravascular Coagulation (blood, diagnosis, drug therapy, microbiology, mortality)
• Female
• Humans
• Intestinal Perforation (complications, diagnosis, microbiology, mortality, surgery)
• Logistic Models
• Male
• Middle Aged
• Odds Ratio
• Propensity Score
• Proportional Hazards Models
• Respiration, Artificial
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Shock, Septic (blood, diagnosis, drug therapy, microbiology, mortality)
• Time Factors
• Treatment Outcome
• Young Adult