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

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 DI...

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Autores principales: Nakahara, Kazunari, Okuse, Chiaki, Adachi, Seitaro, Suetani, Keigo, Kitagawa, Sarika, Okano, Miki, Michikawa, Yosuke, Takagi, Rei, Shigefuku, Ryuta, Itoh, Fumio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Pancreatobiliary Association; Korean Society of Gastrointestinal Cancer 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661971/
https://www.ncbi.nlm.nih.gov/pubmed/23710320
http://dx.doi.org/10.5009/gnl.2013.7.3.363
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author Nakahara, Kazunari
Okuse, Chiaki
Adachi, Seitaro
Suetani, Keigo
Kitagawa, Sarika
Okano, Miki
Michikawa, Yosuke
Takagi, Rei
Shigefuku, Ryuta
Itoh, Fumio
author_facet Nakahara, Kazunari
Okuse, Chiaki
Adachi, Seitaro
Suetani, Keigo
Kitagawa, Sarika
Okano, Miki
Michikawa, Yosuke
Takagi, Rei
Shigefuku, Ryuta
Itoh, Fumio
author_sort Nakahara, Kazunari
collection PubMed
description 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%.
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spelling pubmed-36619712013-05-24 Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis Nakahara, Kazunari Okuse, Chiaki Adachi, Seitaro Suetani, Keigo Kitagawa, Sarika Okano, Miki Michikawa, Yosuke Takagi, Rei Shigefuku, Ryuta Itoh, Fumio Gut Liver Original Article 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%. The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Pancreatobiliary Association; Korean Society of Gastrointestinal Cancer 2013-05 2013-04-25 /pmc/articles/PMC3661971/ /pubmed/23710320 http://dx.doi.org/10.5009/gnl.2013.7.3.363 Text en Copyright © 2013 by the Korean Society of Gastroenterology, the Korean Society of Gastrointestinal Endoscopy, the Korean Society of Neurogastroenterology and Motility, Korean College of Helicobacter and Upper Gastrointestinal Research, Korean Association for the Study of Intestinal Diseases, the Korean Association for the Study of the Liver, Korean Pancreatobiliary Association, and Korean Society of Gastrointestinal Cancer http://creativecommons.org/licenses/by-nc/3.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Nakahara, Kazunari
Okuse, Chiaki
Adachi, Seitaro
Suetani, Keigo
Kitagawa, Sarika
Okano, Miki
Michikawa, Yosuke
Takagi, Rei
Shigefuku, Ryuta
Itoh, Fumio
Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title_full Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title_fullStr Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title_full_unstemmed Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title_short Use of Antithrombin and Thrombomodulin in the Management of Disseminated Intravascular Coagulation in Patients with Acute Cholangitis
title_sort use of antithrombin and thrombomodulin in the management of disseminated intravascular coagulation in patients with acute cholangitis
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3661971/
https://www.ncbi.nlm.nih.gov/pubmed/23710320
http://dx.doi.org/10.5009/gnl.2013.7.3.363
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