The anticoagulant therapy for sepsis-associated disseminated intravascular coagulation

IF 3.7 3区 医学 Q1 HEMATOLOGY Thrombosis research Pub Date : 2013-05-01 DOI:10.1016/j.thromres.2013.03.012
Toshiaki Iba , Isao Nagaoka , Marcel Boulat
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引用次数: 39

Abstract

Sepsis is a leading cause of death in critically ill patients and it requires multidisciplinary treatment. The effects of anticoagulant therapy for sepsis-associated disseminated intravascular coagulation have been long discussed and intensively studied. The recent topics in this area are 1) withdrawal of recombinant activated protein C(rAPC) from the market, 2) potential efficacy of the supplement-dose of antithrombin, 3) success of the recombinant thrombomodulin in a Phase 2B trial.

rAPC had been the only anticoagulant recommended in the global guideline for the treatment of severe sepsis (Surviving Sepsis Campaign guidelines (SSCG) 2008). However, the recommendation was withdrawn from the latest version of SSCG after rAPC could not demonstrate sufficient efficacy in the most recent randomized controlled trial. Antithrombin concentrate is another anticoagulant which can be effective for sepsis-associated disseminated intravascular coagulation (DIC). However, high-dose antithrombin is recommended not to be used in SSCG 2012 since it did not show any survival benefit and increased the bleeding risks in severe sepsis. Nonetheless, a recent clinical study reported the potential efficacy of supplement-dose antithrombin in septic DIC. Recombinant thrombomodulin has been newly developed and its efficacy for DIC was reported. A recent multinational randomized controlled trial has also demonstrated the potential efficacy of this therapeutic agent for septic DIC and a Phase 3 study is currently underway.

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脓毒症相关弥散性血管内凝血的抗凝治疗
脓毒症是危重病人死亡的主要原因,需要多学科治疗。抗凝治疗对脓毒症相关弥散性血管内凝血的影响已被长期讨论和深入研究。该领域最近的主题有:1)重组活化蛋白C(rAPC)退出市场;2)抗凝血酶补充剂量的潜在疗效;3)重组凝血调节蛋白在2B期试验中的成功。在全球严重脓毒症治疗指南(生存脓毒症运动指南(SSCG) 2008)中,rAPC一直是唯一推荐的抗凝剂。然而,在最近的随机对照试验中,rAPC不能证明足够的疗效后,最新版本的SSCG撤回了这一建议。浓缩抗凝血酶是另一种对脓毒症相关弥散性血管内凝血(DIC)有效的抗凝剂。然而,高剂量抗凝血酶不建议用于SSCG 2012,因为它没有显示出任何生存益处,并且增加了严重败血症的出血风险。尽管如此,最近的一项临床研究报道了补充剂量抗凝血酶治疗脓毒性DIC的潜在疗效。重组血栓调节蛋白是一种新开发的药物,并报道了其治疗DIC的疗效。最近的一项多国随机对照试验也证明了这种药物治疗脓毒性DIC的潜在疗效,目前正在进行3期研究。
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来源期刊
Thrombosis research
Thrombosis research 医学-外周血管病
CiteScore
14.60
自引率
4.00%
发文量
364
审稿时长
31 days
期刊介绍: Thrombosis Research is an international journal dedicated to the swift dissemination of new information on thrombosis, hemostasis, and vascular biology, aimed at advancing both science and clinical care. The journal publishes peer-reviewed original research, reviews, editorials, opinions, and critiques, covering both basic and clinical studies. Priority is given to research that promises novel approaches in the diagnosis, therapy, prognosis, and prevention of thrombotic and hemorrhagic diseases.
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