PMID- 30449812
OWN - NLM
STAT- MEDLINE
DCOM- 20190528
LR  - 20200225
IS  - 1349-7235 (Electronic)
IS  - 0918-2918 (Print)
IS  - 0918-2918 (Linking)
VI  - 58
IP  - 7
DP  - 2019 Apr 1
TI  - Efficacy of Combined Thrombomodulin and Antithrombin in Anticoagulant Therapy for 
      Acute Cholangitis-induced Disseminated Intravascular Coagulation.
PG  - 907-914
LID - 10.2169/internalmedicine.1923-18 [doi]
AB  - Objective The efficacy and safety of concomitant use of antithrombin (AT) with 
      recombinant human soluble thrombomodulin (rTM) for acute cholangitis-induced 
      disseminated intravascular coagulation (AC-induced DIC) remains unclear. This 
      study was conducted to investigate the efficacy of AT combined with rTM as 
      anticoagulant therapy for AC-induced DIC. Methods One hundred patients with 
      AC-induced DIC received anticoagulant therapy using rTM from April 2010 to 
      December 2017. Of the 83 patients treated with rTM immediately after the 
      diagnosis of DIC, excluding those who had not undergone biliary drainage or who 
      had malignancies or a serum AT III level >70%, 56 patients were studied. Outcomes 
      and adverse events (AEs) were retrospectively compared between the 16 patients 
      treated with rTM alone (rTM group) and the 40 patients treated with rTM and AT 
      (rTM+AT group). Results Patients' background characteristics did not differ 
      markedly, except for a significantly higher serum D-dimer level in the rTM group 
      than in the rTM+AT group (p=0.038). The DIC resolution rates on day 9 were 100% 
      and 95.1% in the rTM and rTM+AT groups, respectively (p=0.909). The mean DIC 
      scores were significantly lower in the rTM group than in the rTM+AT group on days 
      3 (p=0.012), 5 (p<0.001), 7 (p=0.033), and 9 (p=0.007). The incidence of AEs was 
      6.3% and 10.0% (p=0.941), and the in-hospital mortality rates was 0% and 5.0% 
      (p=0.909) in the rTM and rTM+AT groups, respectively. Conclusion The concomitant 
      use of AT with anticoagulant therapy using rTM for AC-induced DIC may not help 
      improve the treatment outcome.
FAU - Morita, Nozomi
AU  - Morita N
AD  - Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, 
      Japan.
FAU - Nakahara, Kazunari
AU  - Nakahara K
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Morita, Ryo
AU  - Morita R
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Suetani, Keigo
AU  - Suetani K
AD  - Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, 
      Japan.
FAU - Michikawa, Yosuke
AU  - Michikawa Y
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Sato, Junya
AU  - Sato J
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Tsuji, Kensuke
AU  - Tsuji K
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Ikeda, Hiroki
AU  - Ikeda H
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Matsunaga, Kotaro
AU  - Matsunaga K
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Watanabe, Tsunamasa
AU  - Watanabe T
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Matsumoto, Nobuyuki
AU  - Matsumoto N
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
FAU - Okuse, Chiaki
AU  - Okuse C
AD  - Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, 
      Japan.
FAU - Suzuki, Michihiro
AU  - Suzuki M
AD  - Department of Gastroenterology and Hepatology, Kawasaki Municipal Tama Hospital, 
      Japan.
FAU - Itoh, Fumio
AU  - Itoh F
AD  - Department of Gastroenterology and Hepatology, St. Marianna University, School of 
      Medicine, Japan.
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
DEP - 20181119
PL  - Japan
TA  - Intern Med
JT  - Internal medicine (Tokyo, Japan)
JID - 9204241
RN  - 0 (Anticoagulants)
RN  - 0 (Antithrombins)
RN  - 0 (Recombinant Proteins)
RN  - 0 (THBD protein, human)
RN  - 0 (Thrombomodulin)
SB  - IM
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Anticoagulants/adverse effects/*therapeutic use
MH  - Antithrombins/adverse effects/*therapeutic use
MH  - Cholangitis/*complications
MH  - Disseminated Intravascular Coagulation/diagnosis/*drug therapy/etiology
MH  - Drainage
MH  - Drug Therapy, Combination
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Recombinant Proteins/adverse effects/therapeutic use
MH  - Retrospective Studies
MH  - Thrombomodulin/*therapeutic use
MH  - Treatment Outcome
PMC - PMC6478986
OTO - NOTNLM
OT  - acute cholangitis
OT  - antithrombin
OT  - biliary drainage
OT  - disseminated intravascular coagulation
OT  - thrombomodulin
COIS- The authors state that they have no Conflict of Interest (COI).
EDAT- 2018/11/20 06:00
MHDA- 2019/05/29 06:00
PMCR- 2019/04/01
CRDT- 2018/11/20 06:00
PHST- 2018/11/20 06:00 [pubmed]
PHST- 2019/05/29 06:00 [medline]
PHST- 2018/11/20 06:00 [entrez]
PHST- 2019/04/01 00:00 [pmc-release]
AID - 10.2169/internalmedicine.1923-18 [doi]
PST - ppublish
SO  - Intern Med. 2019 Apr 1;58(7):907-914. doi: 10.2169/internalmedicine.1923-18. Epub 
      2018 Nov 19.