Effectiveness of Human Recombinant Thrombomodulin for Septic Disseminated Intravascular Coagulation in Perioperative Care in Digestive Surgery

Purpose: We have administered recombinant human soluble thrombomodulin (rTM) for septic disseminated intravascular coagulation (DIC) since December 2010, because anticoagulant therapy was considered to be important in the treatment of septic DIC in parallel with treatment of the cause of the disease. The aim of this study was to investigate the effects of rTM in patients with septic DIC arising from abdominal disease perioperatively in digestive surgery. Methods: We examined 43 patients with septic DIC arising from abdominal disease perioperatively from 2007. The patients were divided into two groups; 23 patients who were administered rTM (rTM group), and 20 patients who were not administered rTM (non-rTM group) and we compared the patient backgrounds, sepsis treatments, general condition rating score, and outcomes between the two groups. Results: There were no significant differences in the patients’ backgrounds between the two groups. Most of the rTM group received rTM+AT combination therapy. DIC scores in the rTM group improved earlier than the non-rTM group; the rTM group improved significantly on day 3. Non-rTM group improved significantly on day 7. SIRS score in the non-rTM group did not show significant improvement during days 0–7, and the rTM group improved significantly on day 5. The SOFA score on day 7 in the rTM group improved significantly compared with the non-rTM group. White blood cell count, CRP and T. Bil in the non-rTM group were higher than that of the rTM group. There was no significant difference in the duration of hospital stay between the two groups, but ICU stay in the rTM group was significantly shorter. No mortality was observed in the rTM group within 30 days, and the survival rate at 30 days in the rTM group was higher than that of the non-rTM group. Conclusion: It is considered that rTM has not only anti-inflammatory effects but also anticoagulant activity for patients with septic DIC. Rapid improvement for systemic microcirculation by rTM inhibits the progression of organ damage, therefore it may contribute to short-term prognosis. We conclude that rTM administration for septic DIC caused by abdominal disease was effective.