Adequate application of recombinant thrombomodulin for sepsis-associated disseminated intravascular coagulation

Excerpt

Recombinant thrombomodulin (rTM) is widely used for septic disseminated intravascular coagulation (DIC) in Japan. Tagami and colleagues performed an analysis using a nationwide administrative database in Japan and reported that rTM did not reduce the mortality in pneumonia-associated DIC (37.6 % in the rTM group vs 37.0 % in the control group, odds ratio: 1.01 (95 % confidence interval: 0.93 to 1.10)) [1]. They also reported a similar result in patients with bowel perforation-induced DIC [2]. These reports indicate that rTM will not be effective in real clinical practice. In contrast, in a recent issue of Critical Care, Yoshimura and colleagues reported that administration of rTM was significantly associated with reduced mortality in high-risk patients [3]. The same group also reported in their systematic review that the probability of a beneficial effect with rTM increases with increasing baseline risk [4]. …