Clinical Impact of Recombinant Soluble Thrombomodulin for Disseminated Intravascular Coagulation Associated with Severe Acute Cholangitis

• Published in: Gut and liver Vol. 12; no. 4; pp. 471 - 477
• Main Authors: Atsushi Okuda, Takeshi Ogura, Miyuki Imanishi, Akira Miyano, Nobu Nishioka, Kazuhide Higuchi
• Format: Journal Article
• Language: Korean
• Published: 대한소화기학회 30.07.2018
• Subjects: Acute cholangitis; Disseminated intravascular coagulation; Recombinant soluble thrombomodulin; Thrombosis
• ISSN: 1976-2283

Background/Aims: Recently, recombinant human soluble thrombomodulin (rTM) has been developed as a new drug for disseminated intravascular coagulation (DIC). This study aims to evaluate the clinical benefit of rTM in patients with sepsis-induced DIC caused by acute cholangitis who underwent biliary drainage. Methods: Patients were divided into two groups: the rTM therapy group and the non-rTM therapy group. The primary outcome was the DIC resolution rate at 7 days, and the secondary outcome was 28-day mortality rate. Results: Thirty-five patients were treated by rTM, and 36 patients were treated without rTM for DIC. The rate of resolution of DIC at day 7 was significantly higher in the rTM group than in the non-rTM group (82.9% vs 55.6%, p=0.0012). Compared with the non-rTM group, the 28-day survival rate of the r-TM group was significantly higher (rTM vs non-rTM, 91.4% vs 69.4%, p=0.014). According to multivariate analysis, non-rTM (hazard ratio [HR], 2.681) and CRP (HR, 2.370) were factors related to decreased survival. Conclusions: rTM treatment may have a positive impact on improving DIC and survival rates in patients with severe acute cholangitis. (Gut Liver 2018;12:471-477)