Optimal Antithrombin Activity Threshold for Initiating Antithrombin Supplementation in Patients With Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study
Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of suppleme...
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| Published in | Clinical and applied thrombosis/hemostasis Vol. 24; no. 6; pp. 874 - 883 |
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| Main Authors | , , , |
| Format | Journal Article |
| Language | English |
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SAGE Publications
01.09.2018
SAGE PUBLICATIONS, INC |
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| Abstract | Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of supplementation therapy in 1033 patients with sepsis-induced DIC whose antithrombin activity levels were measured upon admission to 42 intensive care units across Japan. Of the 509 patients who had received antithrombin supplementation therapy, in-hospital mortality was significantly reduced only in patients with very low antithrombin activity (≤43%; bottom quartile; adjusted hazard ratio: 0.603; 95% confidence interval: 0.368-0.988; P = .045). Similar associations were not observed in patients with low, moderate, or normal antithrombin activity levels. Supplementation therapy did not correlate with the incidence of bleeding requiring transfusion. The adjusted hazard ratios for in-hospital mortality increased gradually with antithrombin activity only when initial activity levels were very low to normal but plateaued thereafter. We conclude that antithrombin supplementation therapy in patients with sepsis-induced DIC and very low antithrombin activity may improve survival without increasing the risk of bleeding. |
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| AbstractList | Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of supplementation therapy in 1033 patients with sepsis-induced DIC whose antithrombin activity levels were measured upon admission to 42 intensive care units across Japan. Of the 509 patients who had received antithrombin supplementation therapy, in-hospital mortality was significantly reduced only in patients with very low antithrombin activity (≤43%; bottom quartile; adjusted hazard ratio: 0.603; 95% confidence interval: 0.368-0.988; P = .045). Similar associations were not observed in patients with low, moderate, or normal antithrombin activity levels. Supplementation therapy did not correlate with the incidence of bleeding requiring transfusion. The adjusted hazard ratios for in-hospital mortality increased gradually with antithrombin activity only when initial activity levels were very low to normal but plateaued thereafter. We conclude that antithrombin supplementation therapy in patients with sepsis-induced DIC and very low antithrombin activity may improve survival without increasing the risk of bleeding. Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of supplementation therapy in 1033 patients with sepsis-induced DIC whose antithrombin activity levels were measured upon admission to 42 intensive care units across Japan. Of the 509 patients who had received antithrombin supplementation therapy, in-hospital mortality was significantly reduced only in patients with very low antithrombin activity (≤43%; bottom quartile; adjusted hazard ratio: 0.603; 95% confidence interval: 0.368-0.988; P = .045). Similar associations were not observed in patients with low, moderate, or normal antithrombin activity levels. Supplementation therapy did not correlate with the incidence of bleeding requiring transfusion. The adjusted hazard ratios for in-hospital mortality increased gradually with antithrombin activity only when initial activity levels were very low to normal but plateaued thereafter. We conclude that antithrombin supplementation therapy in patients with sepsis-induced DIC and very low antithrombin activity may improve survival without increasing the risk of bleeding. |
| Author | Yamakawa, Kazuma Kudo, Daisuke Ono, Kota Hayakawa, Mineji |
| AuthorAffiliation | 2 Department of Emergency Medicine, Osaka General Medical Center, Osaka, Japan 1 Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan 4 Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan 3 Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan |
| AuthorAffiliation_xml | – name: 4 Clinical Research and Medical Innovation Center, Hokkaido University Hospital, Sapporo, Japan – name: 3 Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan – name: 1 Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan – name: 2 Department of Emergency Medicine, Osaka General Medical Center, Osaka, Japan |
| Author_xml | – sequence: 1 givenname: Mineji surname: Hayakawa fullname: Hayakawa, Mineji – sequence: 2 givenname: Kazuma surname: Yamakawa fullname: Yamakawa, Kazuma – sequence: 3 givenname: Daisuke surname: Kudo fullname: Kudo, Daisuke – sequence: 4 givenname: Kota surname: Ono fullname: Ono, Kota |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/29514467$$D View this record in MEDLINE/PubMed |
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| Keywords | antithrombin mortality transfusion disseminated intravascular coagulation sepsis |
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| SubjectTerms | Aged Antithrombins - administration & dosage Antithrombins - blood Disseminated Intravascular Coagulation - blood Disseminated Intravascular Coagulation - drug therapy Disseminated Intravascular Coagulation - mortality Female Hospital Mortality Humans Male Middle Aged Observational studies Original Retrospective Studies Sepsis Sepsis - blood Sepsis - drug therapy Sepsis - mortality |
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| Title | Optimal Antithrombin Activity Threshold for Initiating Antithrombin Supplementation in Patients With Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study |
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