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Optimal patient selection for anticoagulant therapy in sepsis: an evidenceābased proposal from Japan
- Source :
- Journal of Thrombosis and Haemostasis. 16:462-464
- Publication Year :
- 2018
- Publisher :
- Elsevier BV, 2018.
-
Abstract
- Selecting an appropriate target population is essential to maximize survival benefits of anticoagulant therapy against sepsis. Our meta-analysis of three populations with sepsis and nationwide observational study in Japan showed that anticoagulants improved mortality only in sepsis-induced disseminated intravascular coagulation (DIC) but not in non-DIC. This divergent effect was physiologically explained by host-protective immune responses of local thrombosis, which are mandatory in the early stage of sepsis. Meanwhile, the lack of definitive evidence for survival benefit provided by several trials of sepsis-induced DIC indicated that this condition was probably not the best target of anticoagulants. Our multicenter cohort study including only patients with sepsis-induced DIC showed a survival benefit from recombinant thrombomodulin only in patients with high disease severity. Thus, we believe that the population with sepsis and DIC and high disease severity is the optimal target for anticoagulant therapy. Anticoagulant therapy without appropriate target selection should be avoided because of the increased risk of bleeding with no survival benefit.
- Subjects :
- Risk
medicine.medical_specialty
Thrombomodulin
Population
Hemorrhage
030204 cardiovascular system & hematology
Antithrombins
Sepsis
03 medical and health sciences
0302 clinical medicine
Japan
hemic and lymphatic diseases
Severity of illness
medicine
Humans
Multicenter Studies as Topic
education
Intensive care medicine
Retrospective Studies
Disseminated intravascular coagulation
education.field_of_study
Evidence-Based Medicine
business.industry
Patient Selection
Anticoagulants
030208 emergency & critical care medicine
Hematology
Disseminated Intravascular Coagulation
medicine.disease
Thrombosis
Recombinant Proteins
Observational Studies as Topic
Observational study
business
Cohort study
Subjects
Details
- ISSN :
- 15387836
- Volume :
- 16
- Database :
- OpenAIRE
- Journal :
- Journal of Thrombosis and Haemostasis
- Accession number :
- edsair.doi.dedup.....15a35a32ab3f2d8e9af64b6e900e1409
- Full Text :
- https://doi.org/10.1111/jth.13946