Abstract
BackgroundPrevious studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. However, robust evidence for this idea is lacking. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns.MethodsWe performed propensity score-matched analyses of the nationwide administrative Japanese Diagnosis Procedure Combination inpatient database. We identified patients with severe burns (burn index ≥ 10) who were recorded in the database from 1 July 2010 to 31 March 2013. We compared patients who were administered antithrombin within 2 days of admission (antithrombin group) and those who were not administered antithrombin (control group). The main outcomes were 28-day mortality and ventilator-free days (VFDs).ResultsEligible patients (n = 3223) from 618 hospitals were categorized into either an antithrombin group (n = 152) or control group (n = 3071). Propensity score matching created a matched cohort of 103 pairs with and without antithrombin. Twenty-eight-day mortality was lower in the antithrombin group compared with the control group in propensity-matched analysis (control vs. antithrombin, 47.6 vs. 33.0%; difference, 14.6%; 95% confidence interval [CI] 1.2–28.0). Cox regression analysis showed a significant difference in 28-day in-hospital mortality between the control and antithrombin propensity-matched groups (hazard ratio 0.58; 95% CI 0.37–0.90). There were significantly more VFDs in the antithrombin compared with the control group in propensity score-matched analysis (control vs. antithrombin, 12.6 vs. 16.4 days; difference −3.7; 95% CI −7.2 to −0.12).ConclusionsThis nationwide database study demonstrated that antithrombin use may improve 28-day survival and increase VFDs in patients with severe burns. Further prospective studies are required to confirm these results.
Highlights
Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns
Patient selection and endpoints We identified patients with severe burns [15] who were recorded in the database from 1 July 2010 to 31 March 2013
Patients were divided into an antithrombin group (n = 152) and a control group (n = 3071), from which 103 propensity score-matched pairs were generated (Fig. 1)
Summary
Previous studies have suggested that antithrombin may be beneficial for treating coagulopathy in patients with severe burns. We examined the hypothesis that antithrombin may be effective in treating patients with severe burns. Several previous studies suggested that antithrombin administration may be effective for treating coagulopathy. Tagami et al Ann. Intensive Care (2017) 7:18 in severe burns; there is currently no robust evidence to support this idea [6,7,8,9,10,11,12]. Lavrentieva et al [9] conducted a pilot study (n = 31) to evaluate the efficacy of antithrombin in acute-phase burn-injury patients and found that antithrombin reduced hypercoagulation and improved organ function. The effect of antithrombin on mortality in patients with severe burns remains unknown
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