Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2017; 23(5): 891-898
Published online Feb 7, 2017. doi: 10.3748/wjg.v23.i5.891
Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery
Hirotaka Konishi, Kazuma Okamoto, Katsutoshi Shoda, Tomohiro Arita, Toshiyuki Kosuga, Ryo Morimura, Shuhei Komatsu, Yasutoshi Murayama, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Eigo Otsuji
Hirotaka Konishi, Kazuma Okamoto, Katsutoshi Shoda, Tomohiro Arita, Toshiyuki Kosuga, Ryo Morimura, Shuhei Komatsu, Yasutoshi Murayama, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Eigo Otsuji, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kajii-cho, Kyoto city 6028566, Japan
Author contributions: Konishi H, Okamoto K, Ichikawa D, Fujiwara H and Otsuji E designed the research; Konishi H, Shoda K, Arita T, Kosuga T, Morimura R, Komatsu S, Murayama Y, Shiozaki A, Kuriu Y, Ikoma H, and Nakanishi M performed the research and treated the patients; Konishi H and Okamoto K analyzed the data; Konishi H, Okamoto K and Otsuji E wrote the manuscript.
Institutional review board statement: We did not seek individual ethical approval by the Facility of Science Committee at Kyoto Prefectural University of Medicine because this study was a retrospective observational study without interpositions and with the medical practice necessary for therapeutic purposes.
Informed consent statement: All study participants provided informed written consent prior to their treatments and study enrollment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this study or its publication.
Data sharing statement: The technical appendix, statistical code and dataset are available from the corresponding author at h-koni7@koto.kpu-m.ac.jp.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hirotaka Konishi, MD, PhD, Assistant Researcher, Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kamigyo-ku, 465 Kajii-cho, Kyoto city 6028566, Japan. h-koni7@koto.kpu-m.ac.jp
Telephone: +81-75-2515527 Fax: +81-75-2515522
Received: August 13, 2016
Peer-review started: August 15, 2016
First decision: October 28, 2016
Revised: November 11, 2016
Accepted: November 28, 2016
Article in press: November 28, 2016
Published online: February 7, 2017
Processing time: 161 Days and 12.6 Hours
Abstract
AIM

To investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery.

METHODS

Thirty-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also evaluated.

RESULTS

Abscess formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).

CONCLUSION

Early administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

Keywords: Quick-sequential organ failure assessment; Thrombomodulin-α; Gastrointestinal surgery; Systemic inflammatory response syndrome; Acute disseminated intravascular coagulopathy

Core tip: The present study investigated the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal surgery. DIC frequently developed within 1 wk of surgery. TM-α was frequently administered within 1 d of the DIC diagnosis and was continued for more than 3 d. The duration of TM-α administration and improvements in DIC-associated parameters at 1 wk were better prognostic factors for 28-d survival. TM-α was administered significantly earlier to patients with severe clinical symptoms. The early administration of TM-α and improvements in DIC parameters were essential for the treatment of DIC.