Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

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 ini-tiation 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(qS OFA) 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 q SOFA) 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 qS OFA 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.