87. Recombinant human soluble thrombomodulin for obstetric disseminated intravascular coagulation

Abstract

Introduction Disseminated intravascular coagulation (DIC) is a syndrome characterized by systemic activation of coagulation which results in widespread fibrin deposition and excessive consumptions of platelets and clotting factors. Recombinant human soluble thrombomodulin (rhTM) is a novel anticoagulant agent and reduces excessive thrombin generation and regulates imbalanced activation of coagulation systems. Although the efficacy of rhTM for obstetric DIC is still uncertain, it has been reported that rhTM reduces morbidity and mortality in sepsis-induced DIC patients. Objectives To examine whether rhTM administration could be effective for DIC patients induced by obstetric underlying disorders. Methods This study is a retrospective cohort study in a single perinatal medical center performed between January 2007 and December 2015. Eligibility criteria are obstetric DIC documented on the basis of clinical and laboratory data and association with one or more major underlying obstetric disorders. We evaluated both laboratory findings and clinical conditions at the early phase. Results Sixty-five patients (including 17 preeclampsia patients) admitted to our hospital fulfilled the criteria. Thirty-six were categorized as a rhTM group and twenty-nine were categorized as a control group. Age, delivery method and diagnosis were not different between groups. For details, amount of hemorrhage, laboratory parameters, DIC score and therapeutic intervention were not shown statistically meaningful. After adjusting two groups, treatment by rhTM was associated with significant improvements in platelet levels, D-dimer concentration, fibrinogen levels and PT-INR. The amounts of platelets transfused was significantly lower in a rhTM group (3.02 vs 6.03 units, P = 0.016). None of the adjusted group differences were statistically significant for all types of multiple organ failure. Discussion In DIC patients induced by obstetric underlying disorders, improvements of both clinical conditions and laboratory findings were confirmed in a rhTM group. Further clinical research is expected to clarify the optimal solution for administrating rhTM in obstetric DIC patients.