157. The efficacy of recombinant human soluble thrombomodulin in preeclampsia

Abstract

Introduction Recombinant human soluble thrombomodulin (rhTM) is a novel anti-coagulant agent that regulates the imbalanced coagulation system by reducing the excessive activation of thrombin. rhTM potentially reduces the morbidity and mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC). However, the efficacy of rhTM in obstetric DIC, especially in patients with preeclampsia, has not yet been established. Objectives We performed this study to examine whether the administration of rhTM was a potentially effective treatment for DIC and organ damage in preeclamptic patients. Methods This is a single-center, retrospective cohort study conducted between January 2007 and December 2017 using the records of our hospital. The eligibility criteria were known or suspected obstetric DIC documented on the basis of clinical and laboratory data. Baseline imbalance between patients with and without treatment of rhTM was adjusted using an inverse probability of treatment weighting using propensity scores composed of the following independent variables: initial platelet counts, D-dimer levels, fibrinogen levels, and prothrombin time–international normalized ratio. We evaluated laboratory changes and clinical outcomes in the early phase of obstetric DIC in preeclampsia patients. Results In total, 21 patients admitted to our department during the study period fulfilled the required criteria; of these, 10 and 11 patients were included in the rhTM and control group, respectively. After adjustment, treatment with rhTM was associated with significant improvements in platelet counts (p = 0.036), D-dimer levels (p = 0.009), compared with the control group. Serum creatinine level was significantly improved in rhTM group (p = 0.036), but other laboratory data of organ damage and failure showed no significant difference between the two groups. Discussion rhTM administration was associated with clinical and laboratory improvement in patients with DIC caused by underlying obstetric conditions in patient with preeclampsia. Further clinical research is needed to clarify the optimal application of rhTM in patients with preeclampsia.