scholarly journals Effect of antithrombin Ⅲ among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan

2021 ◽  
Author(s):  
Yudai Iwasaki ◽  
Hiroyuki Ohbe ◽  
Daisuke Shigemi ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Observational Study ◽  
Disseminated Intravascular Coagulation ◽  
Intravascular Coagulation ◽  
Nationwide Observational Study

scholarly journals Effect of antithrombin Ⅲ among patients with disseminated intravascular coagulation in obstetrics: a nationwide observational study in Japan

2021 ◽  
Author(s):  
Yudai Iwasaki ◽  
Hiroyuki Ohbe ◽  
Daisuke Shigemi ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Propensity Score ◽  
Observational Study ◽  
Confidence Interval ◽  
Maternal Mortality ◽  
Propensity Score Matching ◽  
Disseminated Intravascular Coagulation ◽  
Control Group ◽  
Intravascular Coagulation ◽  
Nationwide Observational Study ◽  
Inpatient Database

Abstract Objective: Pregnant women may develop disseminated intravascular coagulation (DIC), possibly resulting in massive maternal haemorrhage and perinatal death. The Japan guideline recommends use of antithrombin Ⅲ (ATⅢ) for DIC in obstetrics; however, its effect remains uncertain. The present study therefore aimed to investigate the effect of ATⅢ for DIC patients in obstetrics, using a national inpatient database in Japan. Design: Nationwide observational study Setting: Japan Population: We used the Diagnosis Procedure Combination inpatient database to identify patients who delivered at hospital and were diagnosed with DIC from July 2010 to March 2018. Methods: Propensity score matching analyses were performed to compare in-hospital maternal mortality and hysterectomy during hospitalization between users and non-users of ATⅢ on the day of delivery. Main Outcome Measures: In-hospital mortality, hysterectomy Results: A total of 9,920 patients were enrolled, including 4,329 patients (44%) who used ATⅢ and 5,511 patients (56%) who did not use ATⅢ. One-to-one propensity score matching created 3290 pairs. In-hospital maternal mortality did not differ significantly between the propensity-matched groups (0.3% in the ATⅢ group vs. 0.5% in the control group; odds ratio, 0.73; 95% confidence interval, 0.35–1.54). Patients in the ATⅢ group, compared with those in the control group, had a significantly lower proportion of receiving hysterectomy during hospitalization (5.3% vs. 8.7%; difference, -2.9%; 95% confidence interval, -4.2 to -1.6%). Conclusions: The present study did not show mortality-reducing effect of ATIII for patients with DIC in obstetrics. ATⅢ may have clinical benefit in terms of reduction in receiving hysterectomy.

scholarly journals Antithrombin use and mortality in patients with stage IV solid tumor-associated disseminated intravascular coagulation: a nationwide observational study in Japan

BMC Cancer ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Kohei Taniguchi ◽  
Hiroyuki Ohbe ◽  
Kazuma Yamakawa ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulation ◽  
Solid Tumor ◽  
Stage Iv ◽  
Therapeutic Strategies ◽  
Control Group ◽  
Intravascular Coagulation ◽  
High Care ◽  
Nationwide Observational Study ◽  
General Wards ◽  
Inpatient Database

Abstract Background Terminal-stage solid tumors are one of the main causes of disseminated intravascular coagulation (DIC); effective therapeutic strategies are therefore warranted. This study aimed to investigate the association between mortality and antithrombin therapy in patients with stage IV solid tumor-associated DIC using a large nationwide inpatient database. Methods From July 2010 to March 2018, patients with stage IV solid tumor-associated DIC in the general wards, intensive care unit, or high care unit were identified using the Japanese Diagnosis Procedure Combination Inpatient Database. Patients who received antithrombin within 3 days of admission were allocated to the antithrombin group, while the remaining patients were allocated to the control group. One-to-four propensity score matching analyses were applied to compare outcomes. The primary outcome was the 28-day in-hospital mortality. Results Of the 25,299 eligible patients, 919 patients had received antithrombin within 3 days of admission and were matched with 3676 patients in the control group. There were no significant differences in the 28-day mortality between the two groups (control vs. antithrombin: 28.9% vs. 30.3%; hazard ratio, 1.08; 95% confidence interval, 0.95–1.23). There were no significant differences in the organ failure score and the proportion of critical bleeding between the two groups. Subgroup analyses showed that the effects of antithrombin were not significantly different among different tumor types. Conclusion Using a nationwide Japanese inpatient database, this study showed that there is no association between antithrombin administration and 28-day mortality in patients with stage IV solid tumor-associated DIC. Therefore, establishing other therapeutic strategies for solid tumor-associated DIC is required.

scholarly journals Associations Among Coagulation-Related Variables, Resolution of Disseminated Intravascular Coagulation (DIC), and Mortality in Patients with Sepsis-Induced DIC Treated with Recombinant Human Soluble Thrombomodulin: A Retrospective Observational Study

2021 ◽  
Author(s):  
Chieko Mitaka ◽  
Izumi Kawagoe ◽  
Daizoh Satoh ◽  
Masakazu Hayashida
Keyword(s):  
Platelet Count ◽  
Observational Study ◽  
Disseminated Intravascular Coagulation ◽  
Early Phase ◽  
Degradation Products ◽  
International Normalized Ratio ◽  
Soluble Thrombomodulin ◽  
Intravascular Coagulation ◽  
Before And After ◽  
Recombinant Human Soluble Thrombomodulin

Abstract Background: We evaluated associations among coagulation-related variables, resolution of disseminated intravascular coagulation (DIC), and mortality in patients with sepsis-induced DIC treated with recombinant human soluble thrombomodulin (rTM). Methods: We retrospectively investigated patients with sepsis-induced DIC treated with rTM. Changes in coagulation-related variables before and after treatment with rTM were examined. Further, associations between coagulation-related variables and DIC resolution were evaluated. Results: A total of 123 patients were included. The platelet count, prothrombin international normalized ratio (PT-INR), and fibrin/fibrinogen degradation products (FDP) significantly (p < 0.001) improved after rTM administration in survivors (n = 98), but not in nonsurvivors (n = 25). However, the DIC score significantly (p < 0.001) reduced not only in survivors but also in nonsurvivors. PT-INR before rTM was significantly (p = 0.0029) lower in patients attaining than not attaining DIC resolution (n = 87 and 36, respectively). The 28-day mortality was significantly lower in patients attaining than not attaining DIC resolution (11.5% vs. 41.7 %, p = 0.0001).Conclusions: The DIC score significantly reduced after rTM in both survivors and nonsurvivors. rTM might play an important role in improving DIC, especially when treatment with rTM is initiated in the early phase of DIC.

Observational study to compare antithrombin and thrombomodulin for disseminated intravascular coagulation

2014 ◽  
Vol 37 (1) ◽  
pp. 139-147 ◽  
Author(s):  
Atsuhiko Murata ◽  
Kohji Okamoto ◽  
Toshihiko Mayumi ◽  
Keiji Muramatsu ◽  
Shinya Matsuda
Keyword(s):  
Observational Study ◽  
Disseminated Intravascular Coagulation ◽  
Intravascular Coagulation

scholarly journals Seasonal Variation and Severity of Acute Abdomen in Japan: A Nine-Year Retrospective Analysis

2021 ◽  
Vol 11 (12) ◽  
pp. 1346
Author(s):  
Hidero Yoshimoto ◽  
Kazuma Yamakawa ◽  
Yutaka Umemura ◽  
Kensuke Fujii ◽  
Eriko Nakamura ◽  
...  
Keyword(s):  
Seasonal Variation ◽  
Observational Study ◽  
Acute Appendicitis ◽  
Acute Abdomen ◽  
Disseminated Intravascular Coagulation ◽  
Seasonal Variations ◽  
Seasonal Incidence ◽  
Intravascular Coagulation ◽  
Failure Assessment ◽  
Acute Hospitals

The seasonal incidence of acute abdomens, such as appendicitis, is reportedly more common in summer but is reported less frequently in Asia. Additionally, seasonal variations in the severity of acute abdomens have been evaluated insufficiently. This study evaluated the seasonal variations in the incidence and severity of acute abdomens in Japan. This retrospective observational study used a multicenter database containing data from 42 acute hospitals in Japan. We included all patients diagnosed with acute appendicitis, diverticulitis, cholecystitis, and cholangitis between January 2011 and December 2019. Baseline patient data included admission date, sequential organ failure assessment score, presence of sepsis, and disseminated intravascular coagulation. We enrolled 24,708 patients with acute abdomen. Seasonal admissions for all four acute abdominal diseases were the highest in summer [acute appendicitis, (OR = 1.35; 95% CI = 1.28–1.43); diverticulitis, (OR = 1.23; 95% CI = 1.16–1.31; cholecystitis (OR = 1.23; 95% CI = 1.11–1.36); and cholangitis (OR = 1.23; 95% CI = 1.12–1.36)]. The proportion of patients with sepsis and disseminated intravascular coagulation as well as the total SOFA score for each disease, did not differ significantly across seasons. Seasonal variations in disease severity were not observed.

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