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

Takashi Tagami; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga

doi:10.1160/TH15-01-0053

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2015; 114(03): 537-545
DOI: 10.1160/TH15-01-0053

Coagulation and Fibrinolysis

Schattauer GmbH

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

Takashi Tagami

¹Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

²Department of Emergency and Critical Care Medicine, Nippon Medical School, Tokyo, Japan

,

Hiroki Matsui

¹Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

,

Kiyohide Fushimi

³Department of Health Informatics and Policy, Tokyo Medical and Dental University, Graduate School of Medicine, Tokyo, Japan

,

Hideo Yasunaga

¹Department of Clinical Epidemiology and Health Economics, School of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

› Institutsangaben

Abstract

Summary

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.

Keywords

Antithrombin - disseminated intravascular coagulation - sepsis - surgery

Volltext

Referenzen

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