Efficacy and safety of antithrombin or recombinant human thrombomodulin in the treatment of disseminated intravascular coagulation: A systematic review and meta-analysis

Abstract

Objective

Multiple organ damage is a hallmark of the highly lethal condition known as disseminated intravascular coagulation (DIC). The efficacy and safety of recombinant human soluble thrombomodulin (rhTM) and antithrombin (AT) in DIC is still debatable. Therefore, we used a fixed-effects model to conduct a comprehensive evaluation and meta-analysis to examine the safety and efficacy of AT or rhTM administration for treating DIC.

Methods

Up until September 2024, the databases of the Cochrane Library, Embase, Web of Science, PubMed, and CNKI were searched for pertinent papers that satisfied the inclusion requirements. Following the researchers' review of the literature, data extraction, and quality assessment, RevMan 5.4 software was used to conduct meta-analysis.

Results

The AT group included two randomized controlled trials with 95 patients, 47 in the test and 48 in the control groups. The test group's DIC resolution rate was higher than the control group's (OR = 5.21 [2.10, 12.90], P = 0.0004), while the 28-day mortality and bleeding-related adverse events did not differ significantly (OR = 0.45 [0.16, 1.31], P = 0.14; OR = 1.02 [0.22, 4.74], P = 0.98). Of the 1105 patients in the rhTM group, 554 were in the trial group and 551 were in the control group across four randomized controlled trials. The trial group showed a greater rate of DIC resolution than the control group (OR = 1.76 [1.34, 2.30], P < 0.0001), although there was no significant difference in the 28-day mortality rate or bleeding-related adverse events. (OR = 0.79 [0.59, 1.05], P = 0.11; OR = 1.08 [0.63, 1.86], P = 0.78).

Conclusion

Both AT and rhTM therapy improved the rate of symptomatic relief in patients with DIC without increasing the risk of bleeding, but there was no benefit in terms of their mortality.