We analyzed the Nationwide Registry database on
sepsis to examine the effects of an anticoagulation
therapy, especially with rh-
thrombomodulin (rh-TM) and/or
antithrombin (AT) III agent, in septic
disseminated intravascular coagulation (
DIC) patients. In 3,193 patients enrolled after the exclusion, we investigated the association with in-hospital mortality using Cox proportional hazards models.
DIC was diagnosed using the Japanese Association of Acute Medicine (JAAM) and the International Society of
Thrombosis and Hemostasis (ISTH) criteria. To analyze the separate treatment effects of rh-TM and/or AT III, we excluded the data of 345 patients treated with all available anticoagulation treatments (rh-TM and/or AT III plus "other
anticoagulants":
protease inhibitors and
heparin/
heparinoids). The
DIC criterion populations were as follows: JAAM DICs, nā=ā1,891 and ISTH DICs (overt
DIC), nā=ā1,002. Septic
DIC patients were divided into 3 groups: Group 1, no anticoagulation
therapy for
DIC; Group 2, received rh-TM and/or AT III; and Group 3, received only "other
anticoagulants." In JAAM
DIC patients, Group 2 did not show an independent association with a reduced risk of in-hospital mortality (hazard ratio [HR]: 0.86; 95% confidence interval [CI]: 0.73-1.01]) as compared with Group 1. However, in ISTH
DIC patients, Group 2 showed an inverse association with the risk of in-hospital mortality (HR 0.74; 95% CI: 0.60-0.92) as compared with Group 1, but the same was not true for Group 3 (HR 0.73; 95% CI: 0.47-1.14). The present results support previous findings of the beneficial effects of anticoagulation
therapies in septic
DIC, also expands the importance of using rh-TM and/or AT agent for septic overt
DIC.