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International Journal of Hematology

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25-01-2024 | Disseminated Intravascular Coagulation | Original Article

A systematic review and meta-analysis of recombinant human soluble thrombomodulin for the treatment of DIC associated with hematological malignancies

Authors: Noriaki Kawano, Masahiko Fukatsu, Kazuma Yamakawa, Yoshinobu Seki, Hideo Wada, Kohji Okamoto, Takayuki Ikezoe

Published in: International Journal of Hematology | Issue 4/2024

Abstract

Background

Recombinant human soluble thrombomodulin (rhTM) is commonly used in Japan to treat disseminated intravascular coagulation (DIC), but its efficacy compared with other anticoagulants is unclear. We conducted a systematic review and meta-analysis to investigate this issue in DIC patients with hematological malignancies.

Methods

We searched PubMed, Cochrane, and Scopus for prospective and retrospective studies evaluating the efficacy and safety of rhTM in DIC patients with hematological malignancies between April 2008 and April 2023. We performed a systematic review and meta-analysis evaluating recovery from DIC, hemorrhagic adverse events (AEs), and overall survival (OS).

Results

We analyzed one prospective (64 patients) and seven retrospective studies (209 patients). Use of rhTM was associated with a higher rate of recovery from DIC (OR: 2.25 [1.09–4.63] and 1.98 [1.12–3.50] in prospective and retrospective studies, respectively; same order below) and fewer hemorrhagic AEs (OR: 0.83 [0.30–2.30] and 0.21 [0.08–0.57]). rhTM did not improve OS (OR: 1.06 [0.42–2.66] and 1.72 [0.87–3.39]), although the incidence of hemorrhagic death was lower in the rhTM group (0 of 94 patients).

Conclusion

Use of rhTM in patients with hematological malignancy-associated DIC is strongly expected to be effective and safe.

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Title: A systematic review and meta-analysis of recombinant human soluble thrombomodulin for the treatment of DIC associated with hematological malignancies
Authors: Noriaki Kawano
Masahiko Fukatsu
Kazuma Yamakawa
Yoshinobu Seki
Hideo Wada
Kohji Okamoto
Takayuki Ikezoe
Publication date: 25-01-2024
Publisher: Springer Nature Singapore
Keywords: Disseminated Intravascular Coagulation
Acute Promyelocytic Leukemia
Cerebral Hemorrhage
Anticoagulant
Heparin
Published in: International Journal of Hematology / Issue 4/2024
Print ISSN: 0925-5710
Electronic ISSN: 1865-3774
DOI: https://doi.org/10.1007/s12185-023-03704-w

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Background

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