Therapeutic Approach of Anticoagulants and Acute Blood Purification for Patients with Sepsis-Induced Disseminated Intravascular Coagulation: Post-marketing Surveillance Data of Antithrombin Supplementation

Backgroud. To improve mortality in patients with sepsis and septic shock, anticoagulant and acute blood purification therapies are performed depends on their severity of organ failure including coagulopathy. Therapeutic approach is required in clinical settings. Material and Methods. We evaluated anticoagulant and acute blood purification therapy in 2,007 patients with sepsis-induced disseminated intravascular coagulation (DIC) in a post-marketing survey examining plasma-derived antithrombin (AT) concentrate. Results. The 28-day mortality rate was 24.2%; before AT administration, there was a significant difference in proportion to the severity of the Sequential Organ Failure Assessment (SOFA) score (p<0.001). The median SOFA score was 9. In patients with SOFA scores >9, the mortality rate was lower in AT combined therapy with recombinant thrombomodulin (rTM) than in AT monotherapy if their JAAM DIC score was >6 (28.5% and 40.0%, respectively; p =0.031). In multiple logistic regression analysis, endotoxin adsorbed polymyxin B-immobilized fiber column direct hemoperfusion (PMX-DHP) before AT administration was correlated with reduced 28-day mortality (odds ratios: 2.071; 95% confidence intervals 1.374–3.121, p=0.001). Conclusions. To improve mortality in patients with sepsis, if patients with endotoxin-induced septic shock, PMX-DHP would undergo, and further development to DIC, AT concentrate administer, followed by rTM if their SOFA and JAAM DIC scores are >9 and 6, respectively. Further prospective study is needed.