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

Authors

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

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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