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Abstract

Impact of anticoagulant therapy on mortality for sepsis-associated disseminated intravascular coagulation depending on the source of infection.

Introduction: Sepsis can be caused by various infections, and coexistence of Disseminated Intravascular Coagulation (DIC) exacerbates mortality. Reportedly, anticoagulant therapy could be associated with a survival benefit in patients with sepsis-associated DIC. The use of Antithrombin (AT) replacement therapy and Recombinant Thrombomodulin (RTM) preparations are typically applied as part of anticoagulant therapy, but which therapeutic modality should be prioritized is unclear. Objectives: This study aimed to clarify whether anticoagulant therapies affect mortality depending on the source of infection and identify the suitable treatment, AT or RTM, based on the source of infection. Patients and Methods: This single-center retrospective cohort study involved 297 patients with sepsis-associatedDIC treated by either AT replacement therapy or RTM preparation. Participants were categorized into the following five groups according to the source of infection: pulmonary, intestine-related, biliary tract, urinary tract, and catheter-related bloodstream infection groups. To assess the clinical efficacy of AT or RTM depending on the source of infection, 90-day mortality was examined using a Cox proportional hazard model. Results: AT replacement therapy reduced the mortality in pulmonary infection (Hazard Ratio (HR), 0.461; 95% Confidence Interval (CI), 0.215â??0.992; P=0.048), and RTM preparation did in biliary tract infection (HR, 2.675; 95% CI, 1.037â??6.900; P=0.042). Conclusion: The impact of anticoagulant therapies showed different influence depending on the source of infection, and we suggest that it is necessary to properly use of AT replacement therapy and RTM preparations.
Author(s):

Makoto Kobayashi.



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