The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis

Tomoaki Yatabe, Shigeaki Inoue, So Sakamoto, Yuka Sumi, Osamu Nishida, Kei Hayashida, Yoshitaka Hara, Tatsuma Fukuda, Asako Matsushima, Akihisa Matsuda, Hideto Yasuda, Kazuto Yamashita, Moritoki Egi

Research output: Contribution to journalArticle

Abstract

Introduction: The benefits and harm caused by anticoagulant treatments for sepsis induced disseminated intravascular coagulation (DIC) remain unclear. Therefore, we performed a network meta-analysis to assess the effect of available anticoagulant treatments on patient mortality, DIC resolution and the incidence of bleeding complication in patients with septic DIC. Materials and methods: We considered all studies from four recent systematic reviews and searched the PubMed, MEDLINE, and Cochrane databases for other studies that investigated anticoagulant treatment for septic DIC using antithrombin, thrombomodulin, heparin, or protease inhibitors in adult critically ill patients. These four anticoagulants and placebo were compared. The primary outcome in this study was patient mortality, and the secondary outcomes were the DIC resolution rate and incidence of bleeding complications. Results: The network meta-analysis included 1340 patients from nine studies. There were no significant differences in the risks of mortality and bleeding complications among all direct comparisons and the network meta-analysis. Using a placebo was associated with a significantly lower rate of DIC resolution, compared to antithrombin in the direct comparison (odds ratio [OR]: 0.20, 95% credible interval [95% CrI]: 0.046–0.81) and in the network meta-analysis (OR: 0.20, 95% CrI: 0.043–0.84). Conclusions: Our study revealed no significant differences in the risks for mortality and bleeding complications when a placebo and all four anticoagulants were compared in septic DIC patients. The results also indicated that antithrombin was associated with a five-fold higher likelihood of DIC resolution, compared to placebo.

Original languageEnglish
Pages (from-to)136-142
Number of pages7
JournalThrombosis Research
Volume171
DOIs
Publication statusPublished - 2018 Nov 1

Fingerprint

Disseminated Intravascular Coagulation
Anticoagulants
Sepsis
Antithrombins
Placebos
Hemorrhage
Mortality
Therapeutics
Odds Ratio
Thrombomodulin
Network Meta-Analysis
Incidence
Protease Inhibitors
PubMed
Critical Illness
MEDLINE
Heparin
Outcome Assessment (Health Care)
Databases

Keywords

  • Anticoagulant treatment
  • Disseminated intravascular coagulation
  • Network meta-analysis
  • Sepsis

ASJC Scopus subject areas

  • Hematology

Cite this

The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis. / Yatabe, Tomoaki; Inoue, Shigeaki; Sakamoto, So; Sumi, Yuka; Nishida, Osamu; Hayashida, Kei; Hara, Yoshitaka; Fukuda, Tatsuma; Matsushima, Asako; Matsuda, Akihisa; Yasuda, Hideto; Yamashita, Kazuto; Egi, Moritoki.

In: Thrombosis Research, Vol. 171, 01.11.2018, p. 136-142.

Research output: Contribution to journalArticle

Yatabe, T, Inoue, S, Sakamoto, S, Sumi, Y, Nishida, O, Hayashida, K, Hara, Y, Fukuda, T, Matsushima, A, Matsuda, A, Yasuda, H, Yamashita, K & Egi, M 2018, 'The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis', Thrombosis Research, vol. 171, pp. 136-142. https://doi.org/10.1016/j.thromres.2018.10.007
Yatabe, Tomoaki ; Inoue, Shigeaki ; Sakamoto, So ; Sumi, Yuka ; Nishida, Osamu ; Hayashida, Kei ; Hara, Yoshitaka ; Fukuda, Tatsuma ; Matsushima, Asako ; Matsuda, Akihisa ; Yasuda, Hideto ; Yamashita, Kazuto ; Egi, Moritoki. / The anticoagulant treatment for sepsis induced disseminated intravascular coagulation; network meta-analysis. In: Thrombosis Research. 2018 ; Vol. 171. pp. 136-142.
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AU - Nishida, Osamu

AU - Hayashida, Kei

AU - Hara, Yoshitaka

AU - Fukuda, Tatsuma

AU - Matsushima, Asako

AU - Matsuda, Akihisa

AU - Yasuda, Hideto

AU - Yamashita, Kazuto

AU - Egi, Moritoki

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AB - Introduction: The benefits and harm caused by anticoagulant treatments for sepsis induced disseminated intravascular coagulation (DIC) remain unclear. Therefore, we performed a network meta-analysis to assess the effect of available anticoagulant treatments on patient mortality, DIC resolution and the incidence of bleeding complication in patients with septic DIC. Materials and methods: We considered all studies from four recent systematic reviews and searched the PubMed, MEDLINE, and Cochrane databases for other studies that investigated anticoagulant treatment for septic DIC using antithrombin, thrombomodulin, heparin, or protease inhibitors in adult critically ill patients. These four anticoagulants and placebo were compared. The primary outcome in this study was patient mortality, and the secondary outcomes were the DIC resolution rate and incidence of bleeding complications. Results: The network meta-analysis included 1340 patients from nine studies. There were no significant differences in the risks of mortality and bleeding complications among all direct comparisons and the network meta-analysis. Using a placebo was associated with a significantly lower rate of DIC resolution, compared to antithrombin in the direct comparison (odds ratio [OR]: 0.20, 95% credible interval [95% CrI]: 0.046–0.81) and in the network meta-analysis (OR: 0.20, 95% CrI: 0.043–0.84). Conclusions: Our study revealed no significant differences in the risks for mortality and bleeding complications when a placebo and all four anticoagulants were compared in septic DIC patients. The results also indicated that antithrombin was associated with a five-fold higher likelihood of DIC resolution, compared to placebo.

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