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.

Treatment with Antithrombin or Thrombomodulin and Mortality from Heatstroke-Induced Disseminated Intravascular Coagulation: A Nationwide Observational Study

2019 ◽  
Vol 45 (08) ◽  
pp. 760-766
Author(s):  
Hiroyuki Ohbe ◽  
Shunsuke Isogai ◽  
Taisuke Jo ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Treatment Group ◽  
Confidence Interval ◽  
Hospital Mortality ◽  
Disseminated Intravascular Coagulation ◽  
Risk Difference ◽  
Control Group ◽  
Robust Analysis ◽  
Intravascular Coagulation ◽  
Doubly Robust ◽  
Inpatient Database

AbstractHeatstroke-induced disseminated intravascular coagulation represents potential targets for specific intensive treatments. However, the effect of antithrombin or thrombomodulin treatment remains uncertain. Using a large nationwide inpatient database in Japan, this study aimed to evaluate whether treatment with antithrombin or thrombomodulin could reduce mortality among patients with heatstroke-induced disseminated intravascular coagulation. Using the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017, we identified heatstroke patients who developed disseminated intravascular coagulation. We allocated patients who started treatment with antithrombin or thrombomodulin within 2 days after admission to the treatment group and allocated others to the control group. A primary outcome was in-hospital mortality. We used a doubly robust analysis to ensure the robustness of our findings. We also conducted two sensitivity analyses for thrombomodulin versus others and antithrombin versus others. We identified 1,606 eligible patients during the 81-month study period. Of these, 556 (35%) received antithrombin or thrombomodulin. The doubly robust analysis demonstrated that in-hospital mortality was significantly lower among patients in the treatment group than among those in the control group (risk difference −6.5%; 95% confidence interval: −12 to −1.4%). In-hospital mortality was significantly lower in patients with thrombomodulin than in others (risk difference −5.5%; 95% confidence interval: −9.5 to −1.6%). There was no significant difference in in-hospital mortality between patients with antithrombin and others (risk difference −4.2%; 95% confidence interval: −9.3 to 0.9%). Treatment with recombinant human thrombomodulin may be associated with lower in-hospital mortality among patients with heatstroke-induced disseminated intravascular coagulation.

Recombinant human soluble thrombomodulin and mortality in sepsis-induced disseminated intravascular coagulation

2016 ◽  
Vol 115 (06) ◽  
pp. 1157-1166 ◽  
Author(s):  
Kazuma Yamakawa ◽  
Shinjiro Saito ◽  
Shigehiko Uchino ◽  
Daisuke Kudo ◽  
Yusuke Iizuka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Confidence Interval ◽  
Disseminated Intravascular Coagulation ◽  
Bleeding Complications ◽  
Control Group ◽  
Clinical Settings ◽  
Soluble Thrombomodulin ◽  
Intravascular Coagulation ◽  
All Cause Mortality ◽  
Recombinant Human Soluble Thrombomodulin

SummaryRecombinant human soluble thrombomodulin (rhTM) is a novel class of anticoagulants for treating disseminated intravascular coagulation (DIC). Although rhTM is widely used in clinical settings throughout Japan, there is limited clinical evidence supporting the use of rhTM in patients with sepsis-induced DIC. Furthermore, rhTM is not approved for DIC treatment in other countries. This study aimed to clarify the survival benefits of rhTM administration in critically ill patients. Data from 3,195 consecutive adult patients who were admitted to 42 intensive care units for the treatment of severe sepsis or septic shock between January 2011 and December 2013 were retrospectively analysed, and 1,784 patients were diagnosed with DIC based on the scoring algorithm from the Japanese Association for Acute Medicine DIC (n = 645, rhTM group; n = 1,139, control group). Propensity score matching created 452 matched pairs, and logistic regression analysis revealed a significant association between rhTM administration and lower in-hospital all-cause mortality in the propensity score-matched groups (odds ratio, 0.757; 95 % confidence interval, 0.574–0.999, p = 0.049). Inverse probability of treatment weighted and quintile-stratified analyses also revealed significant associations between rhTM administration and lower in-hospital all-cause mortality. Survival time in the propensity score-matched rhTM group was significantly longer than that in the propensity score-matched control group (hazard ratio, 0.781; 95 % confidence interval, 0.624–0.977, p = 0.03). Bleeding complications were not more frequent in the rhTM groups. In conclusion, this study demonstrated that rhTM administration is associated with reduced in-hospital all-cause mortality among patients with sepsis-induced DIC.

scholarly journals In-Hospital Mortality After Blood Purification With and Without Acrylonitrile-Co-Methallyl Sulfonate Surface-Treated Membrane for Pneumonia-Associated Sepsis: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Kentaro Hayashi ◽  
Yusuke Sasabuchi ◽  
Hiroki Matsui ◽  
Mikio Nakajima ◽  
Hiroyuki Ohbe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Mortality Rate ◽  
Propensity Score ◽  
Hospital Mortality ◽  
Propensity Score Matching ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Control Group ◽  
Diagnosis Procedure Combination ◽  
Inpatient Database

Abstract Background: Cytokine removal therapy is one of the available therapies for sepsis. Acrylonitrile-co-methallyl sulfonate surface-treated (AN69ST, sepXiris®) membrane has cytokine adsorption capacity and has been widely used for treating sepsis in Japan. The aim of this study was to compare the effects of continuous renal replacement therapy (CRRT) with AN69ST membrane and conventional CRRT for patients with pneumonia-associated sepsis.Methods: We conducted a retrospective cohort study using the Diagnosis Procedure Combination database, a nationwide inpatient database in Japan. We identified adult patients who were hospitalized due to pneumonia and received CRRT within 2 days of admission from September 2014 to March 2017. We included patients who received CRRT with AN69ST membrane within 2 days of admission in the treatment group (AN69ST group); those who received CRRT with other membranes within 2 days of admission were included in the control group (non-AN69ST group). Propensity score matching was used to compare in-hospital mortality between the two groups.Results: Eligible patients (n=2,393) were categorized into the AN69ST group (n=631) or the non-AN69ST group (n=1,762). The overall in-hospital mortality rate in pneumonia patients treated with CRRT was 38.9%. Propensity score matching created a matched cohort of 545 pairs of patients. The in-hospital mortality rate was significantly lower in the AN69ST group than in the non-AN69ST group (35.8 vs. 41.8%, p=0.046).Conclusion: Our data suggest that CRRT with the AN69ST membrane was associated with a significantly lower in-hospital mortality than CRRT with standard membranes among patients with pneumonia-associated sepsis.

Recombinant Thrombomodulin in Disseminated Intravascular Coagulation Associated with Stage IV Solid Tumors: A Nationwide Observational Study in Japan

2020 ◽  
Author(s):  
Kohei Taniguchi ◽  
Hiroyuki Ohbe ◽  
Kazuma Yamakawa ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
...  
Keyword(s):  
Solid Tumors ◽  
Disseminated Intravascular Coagulation ◽  
Gynecological Cancer ◽  
Stage Iv ◽  
Control Group ◽  
Soluble Thrombomodulin ◽  
Entire Cohort ◽  
Intravascular Coagulation ◽  
Significant Difference ◽  
Inpatient Database

Abstract Objective The terminal stage of solid tumors sometimes induces disseminated intravascular coagulation (DIC); however, no useful therapeutic strategies have been established. This study investigated the relationship between mortality and recombinant human soluble thrombomodulin (rTM) therapy for patients with DIC associated with stage IV solid tumors using a large nationwide inpatient database. Methods Using the Japanese Diagnosis Procedure Combination Inpatient Database, patients with stage IV solid tumors who developed DIC were identified. Those who received rTM within 3 days of admission were included in the treatment group; the remaining were included in the control group. The primary outcome was the 28-day in-hospital mortality. Results Of 25,299 eligible patients, 1 to 4 propensity score matching was used to select 1,979 rTM users and 7,916 nonusers. There was no significant difference in the 28-day mortality (control vs. rTM: 37.4% vs. 34.3%; hazard ratio, 0.95; 95% confidence interval [CI], 0.88–1.04) and critical bleeding rate (control vs. rTM: 3.7% vs. 3.8%; odds ratio, 1.04; 95% CI, 0.75–1.42) between groups. Subgroup analyses showed that the 28-day mortality rate among patients with colorectal and gynecological cancer was significantly lower in the rTM than in the control group (p for interaction 0.033 and 0.010, respectively). Conclusion Although we identified a possibly beneficial association between rTM administration and mortality in specific populations of patients with colorectal and gynecological cancer, no such association was found when considering the entire cohort of patients with DIC associated with stage IV solid tumors.

Supplemental dose of antithrombin use in disseminated intravascular coagulation patients after abdominal sepsis

2015 ◽  
Vol 114 (09) ◽  
pp. 537-545 ◽  
Author(s):  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga ◽  
Takashi Tagami
Keyword(s):  
Propensity Score ◽  
Disseminated Intravascular Coagulation ◽  
Abdominal Sepsis ◽  
Administrative Database ◽  
Control Group ◽  
Emergency Laparotomy ◽  
Intravascular Coagulation ◽  
Significant Difference ◽  
Mortality Difference ◽  
Supplemental Dose

SummaryThe effectiveness of supplemental dose antithrombin administration (1,500 to 3,000 IU/ day) for patients with sepsis-associated disseminated intravascular coagulation (DIC), especially sepsis due to abdominal origin, remains uncertain. This was a retrospective cohort study of patients with mechanically ventilated septic shock and DIC after emergency surgery for perforation of the lower intestinal tract using a nationwide administrative database, Japanese Diagnosis Procedure Combination inpatient database. A total of 2,164 patients treated at 612 hospitals during the 33-month study period between 2010 and 2013 were divided into an antithrombin group (n=1,021) and a control group (n=1,143), from which 518 propensity score-matched pairs were generated. Although there was no significant 28-day mortality difference between the two groups in the unmatched groups (control vs antithrombin: 25.7 vs 22.9 %; difference, 2.8 %; 95 % confidence interval [CI], –0.8–6.4), a significant difference existed between the two groups in propensity-score weighted groups (26.3 vs 21.7 %; difference, 4.6 %; 95 % CI, 2.0–7.1) and propensity-score matched groups (27.6 vs 19.9 %; difference, 7.7 %; 95 % CI, 2.5–12.9). Logistic regression analyses showed a significant association between antithrombin use and lower 28-day mortality in propensity-matched groups (odds ratio, 0.65; 95 % CI, 0.49–0.87). Analysis using the hospital antithrombin-prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 6.5 % (95 % CI, 0.05–13.0) reduction in 28-day mortality. Supplemental dose of antithrombin administration may be associated with reduced 28-day mortality in sepsis-associated DIC patients after emergency laparotomy for intestinal perforation.

scholarly journals Effects of Polymyxin B Hemoperfusion on Septic Shock Patients Requiring Noradrenaline: Analysis of a Nationwide Administrative Database in Japan

2021 ◽  
pp. 1-6
Author(s):  
Kenji Fujimori ◽  
Kunio Tarasawa ◽  
Kiyohide Fushimi
Keyword(s):  
Septic Shock ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Polymyxin B ◽  
Administrative Database ◽  
Control Group ◽  
Continuous Hemodiafiltration ◽  
Significant Survival ◽  
Maximum Daily Dose ◽  
Polymyxin B Hemoperfusion

<b><i>Introduction:</i></b> Polymyxin B hemoperfusion (PMX) reduces endotoxin in septic shock patients’ blood and can improve hemodynamics and organ functions. However, its effects on the reduction of septic shock mortality are controversial. <b><i>Methods:</i></b> Using the Japanese diagnosis procedure combination database from April 2016 to March 2019, we identified adult septic shock patients treated with noradrenaline. This study used propensity score matching to compare the outcome between PMX-treated and non-treated patients. The primary endpoint was 28-day mortality, counting from the day of noradrenaline initiation. The secondary endpoints were noradrenaline-, ventilator-, and continuous hemodiafiltration (CHDF)-free days at day 28. <b><i>Results:</i></b> Of 30,731 eligible patients, 4,766 received PMX. Propensity score matching produced a matched cohort of 4,141 pairs with well-balanced patient backgrounds. The 28-day survival rate was 77.9% in the PMX group and 71.1% in the control group (<i>p</i> &#x3c; 0.0001). Median days of noradrenalin-, CHDF-, and ventilator-free days were 2 days (<i>p</i> &#x3c; 0.0001), 2 days (<i>p</i> &#x3c; 0.0001), and 6 days (<i>p</i> &#x3c; 0.0001) longer in the PMX group than in the control group, respectively. When stratified with the maximum daily dose of noradrenaline, the PMX group showed a statistically significant survival benefit in the groups with noradrenaline dose &#x3c;20 mg/day but not in the noradrenaline group dose ≥20 mg/day. <b><i>Conclusion:</i></b> Analysis of large Japanese databases showed that septic shock patients who received noradrenaline might benefit from PMX treatment.

scholarly journals Bicyclol for the treatment of drug-induced liver injury: a propensity score matching analysis using a nationwide inpatient database

2021 ◽  
Vol 49 (4) ◽  
pp. 030006052110059
Author(s):  
Yongfeng Wang ◽  
Rongtao Lai ◽  
Peilan Zong ◽  
Qingling Xu ◽  
Jia Shang ◽  
...  
Keyword(s):  
Liver Injury ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Statistical Significance ◽  
Control Group ◽  
Time Interval ◽  
Potential Candidate ◽  
Drug Induced ◽  
Drug Induced Liver Injury ◽  
Propensity Score Matching Analysis

ObjectiveTo evaluate the efficacy and safety of bicyclol in patients with drug-induced liver injury (DILI) using a nationwide database.MethodsWe retrospectively analyzed the clinical data of DILI patients in the DILI-R database. Propensity score matching was performed to balance the bicyclol and control groups, and alanine aminotransferase (ALT) recovery was compared between the two groups. Factors associated with ALT recovery and safety were identified.ResultsThe analysis included the data of 25,927 patients. Eighty-seven cases were included in the bicyclol group, with 932 cases in the control group. One-to-one propensity score matching created 86 matched pairs. The ALT normalization rate in the bicyclol group was significantly higher than that in the control group (50.00% vs. 24.42%), and statistical significance was found in the superiority test. After adjustment of baseline ALT levels, baseline total bilirubin levels, sex, age, acute or chronic liver diseases, and suspected drugs in the multivariate logic regression analysis, the major influencing factors for ALT recovery included the time interval between ALT tests (days) and the group factor (bicyclol treatment). There were no differences in the proportion of renal function impairment or blood abnormalities between the two groups.ConclusionsBicyclol is a potential candidate for DILI.

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