Effects of Recombinant Human Soluble Thrombomodulin Treatment for Disseminated Intravascular Coagulation at a Single Institution -An Analysis of 62 Cases Caused by Infectious Diseases and 30 Cases Caused by Hematological Diseases

Noriaki Kawano; Akira Tasaki; Takuro Kuriyama; Yoshihiro Tahara; Shuro Yoshida; Nobuyuki Ono; Daisuke Himeji; Kiyoshi Yamashita; Yoshihiro Shibata; Toshiyuki Goto; Tomohiro Inoue; Naoko Yokota-Ikeda; Shigehiro Uezono; Akihiko Yuge; Toshihiro Nishiguchi; Tamahiro Kinjo; Yasuhiro Ogura; Kiichiro Beppu; Yuji Ueda; Mariko Kinoshita; Hiroshi Moritake; Kazuya Shimoda; Hidenobu Ochiai; Akira Ueda

doi:10.2169/internalmedicine.53.0715

ORIGINAL ARTICLES

Effects of Recombinant Human Soluble Thrombomodulin Treatment for Disseminated Intravascular Coagulation at a Single Institution -An Analysis of 62 Cases Caused by Infectious Diseases and 30 Cases Caused by Hematological Diseases

Noriaki Kawano, Akira Tasaki, Takuro Kuriyama, Yoshihiro Tahara, Shuro Yoshida, Nobuyuki Ono, Daisuke Himeji, Kiyoshi Yamashita, Yoshihiro Shibata, Toshiyuki Goto, Tomohiro Inoue, Naoko Yokota-Ikeda, Shigehiro Uezono, Akihiko Yuge, Toshihiro Nishiguchi, Tamahiro Kinjo, Yasuhiro Ogura, Kiichiro Beppu, Yuji Ueda, Mariko Kinoshita, Hiroshi Moritake, Kazuya Shimoda, Hidenobu Ochiai, Akira Ueda

Author information

Noriaki Kawano
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Akira Tasaki
Department of Intensive Care Unit, Miyazaki Prefectural Miyazaki Hospital, Japan
Takuro Kuriyama
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Yoshihiro Tahara
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Shuro Yoshida
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Nobuyuki Ono
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Daisuke Himeji
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Kiyoshi Yamashita
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Yoshihiro Shibata
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Toshiyuki Goto
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Tomohiro Inoue
Department of Dermatology, Miyazaki Prefectural Miyazaki Hospital, Japan
Naoko Yokota-Ikeda
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Shigehiro Uezono
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan
Akihiko Yuge
Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Japan
Toshihiro Nishiguchi
Department of Pediatrics, Miyazaki Prefectural Miyazaki Hospital, Japan
Tamahiro Kinjo
Department of Cardiovascular Surgery, Miyazaki Prefectural Miyazaki Hospital, Japan
Yasuhiro Ogura
Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Japan
Kiichiro Beppu
Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Japan
Yuji Ueda
Department of Surgery, Miyazaki Prefectural Miyazaki Hospital, Japan
Mariko Kinoshita
Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Japan
Hiroshi Moritake
Division of Pediatrics, Department of Reproductive and Developmental Medicine, Faculty of Medicine, University of Miyazaki, Japan
Kazuya Shimoda
Division of Gastroenterology and Hematology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Japan
Hidenobu Ochiai
Trauma and Critical Care Center, Faculty of Medicine, University of Miyazaki Hospital, Japan
Akira Ueda
Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Japan

Keywords: disseminated intravascular coagulation, recombinant human soluble thrombomodulin, the criteria of the Japanese Association for Acute Medicine, the criteria of the Japanese Ministry of Health and Welfare, early treatment at a low score of DIC

JOURNAL OPEN ACCESS

2014 Volume 53 Issue 3 Pages 205-213

DOI https://doi.org/10.2169/internalmedicine.53.0715

Details

Abstract

Objective Disseminated intravascular coagulation (DIC) is a clinical condition with high mortality that is characterized by the systemic activation of coagulation pathways resulting in multiple organ failure. Although no standard treatment for DIC has been established, recent reports have indicated that recombinant human soluble thrombomodulin (rTM) is effective against DIC.
Methods To elucidate the clinical characteristics and outcomes of DIC, we retrospectively analyzed 92 DIC patients who were treated with rTM at Miyazaki Prefectural Hospital over a 4-year period (62 patients had infectious diseases and 30 patients had hematological diseases). A diagnosis of DIC was made based on the diagnostic criteria of the Japanese Association for Acute Medicine (JAAM) and Japanese Ministry of Health and Welfare (JMHW) for infectious diseases and hematological diseases, respectively. In addition to treating the underlying disease, rTM was administered for six consecutive days.
Results In this study, 49 of the 92 DIC patients (53.3%) experienced resolution of DIC seven days after administration (46.8% patients with infectious disease and 66.7% with hematological disease). A higher survival rate was observed after a 28-day observation period in 69 of the 92 patients (75.0%) (72.6% of the patients with infectious disease and 80.0% of the patients with hematological disease). A lower DIC score at the initiation of rTM treatment was closely related to a higher rate of resolution of DIC.
Conclusion Our findings indicate that rTM therapy is an effective, safe and feasible treatment for DIC patients. Furthermore, making an accurate and early diagnosis of DIC and providing subsequent immediate treatment with rTM may improve the resolution of DIC.

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