Gut Liver.  2013 May;7(3):363-370. 10.5009/gnl.2013.7.3.363.

Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis

• Nakahara K
• Okuse C
• Adachi S
• Suetani K
• Kitagawa S
• Okano M
• Michikawa
• Takagi R
• Shigefuku
• Itoh F

• KMID: 1431356
• DOI: http://doi.org/10.5009/gnl.2013.7.3.363

Abstract

BACKGROUND/AIMS
To evaluate the usefulness and safety of treating disseminated intravascular coagulation (DIC) complicating cholangitis primarily with antithrombin (AT) and thrombomodulin (rTM).
METHODS
A DIC treatment algorithm was determined on the basis of plasma AT III levels at the time of DIC diagnosis and DIC score changes on treatment day 3. Laboratory data and DIC scores were assessed prospectively at 2-day intervals.
RESULTS
DIC reversal rates >75% were attained on day 7. In the DIC reversal group, statistically significant differences from baseline were observed in interleukin-6 and C-reactive protein levels within 5 days. Patients with no DIC score improvements after treatment with AT alone experienced slow improvement on a subsequent combination therapy with rTM. Although a subgroup with biliary drainage showed greater improvement in DIC scores than did the nondrainage subgroup, the mean DIC score showed improvement even in the nondrainage subgroup alone. Gastric cancer bleeding that was treated conservatively occurred in one patient. As for day 28 outcomes, three patients died from concurrent malignancies.
CONCLUSIONS
Although this algorithm was found to be useful and safe for DIC patients with cholangitis, it may be better to administer rTM and AT simultaneously from day 1 if the plasma AT III level is less than 70%.

Keyword

Disseminated intravascular coagulation; Cholangitis; Antithrombins; Thrombomodulin

MeSH Terms

Antithrombin III
Antithrombins
C-Reactive Protein
Cholangitis
Dacarbazine
Disseminated Intravascular Coagulation
Drainage
Hemorrhage
Humans
Interleukin-6
Plasma
Prospective Studies
Stomach Neoplasms
Thrombomodulin
Antithrombin III
Antithrombins
C-Reactive Protein
Dacarbazine
Interleukin-6
Thrombomodulin