Two cases of heatstroke-induced disseminated intravascular coagulation treated successfully with thrombomodulin alfa

• Published in: Nihon Kyukyu Igakukai Zasshi Vol. 24; no. 6; pp. 367 - 373
• Main Authors: Sakurai, Toshihiro, Yamada, Syu, Kitada, Maki, Hashimoto, Satoshi, Harada, Masahiro, Kimura, Fumihiko, Takahashi, Takeshi
• Format: Journal Article
• Language: Japanese
• Published: Japanese Association for Acute Medicine 15.06.2013
• Subjects: anti-coagulation; anti-inflammation; cytoprotection
• ISSN: 0915-924X; 1883-3772
• DOI: 10.3893/jjaam.24.367

Heatstroke causes various complications, frequently resulting in hepatic and renal dysfunction. Altered consciousness, rhabdomyolysis, shock, disseminated intravascular coagulation (DIC), and multiple organ failure are observed in serious cases. DIC results from peripheral circulatory failure due to severe hypovolemia, heat-induced direct tissue and vascular endothelial cell damage, hypercytokinemia, bacterial translocation due to increased permeability of the intestinal mucosa, and hemorrhagic diathesis caused by hepatic dysfunction-induced decreased coagulation factor synthesis. Standard anticoagulant therapy protocols have not yet been established for DIC due to heatstroke. We treated two patientsof heatstroke-induced DIC with recombinant thrombomodulin alpha (rTM). Both patients were elderly and had classical heatstroke. They were stuporous and developed hepatic and renal dysfunction. Their scores based on the Japanese Association for Acute Medicine criteria for DIC diagnosis were 5 and 7 points, respectively. They received anticoagulation therapy. They were administered rTM monotherapy, and rTM with gabexate mesilate combination therapy, respectively. The condition of both the patients improved without hemorrhagic complications, and they recovered from DIC ondays 5 and 14 after admission, respectively. They were transferred to different hospitals ondays 57 and 27 after admission, respectively, without side effects. Therefore, we suggest that rTM therapy is effective for heatstroke-induced DIC.