The risks and benefits of disseminated intravascular coagulation-targeted anticoagulant therapy in abdominal sepsis.

BACKGROUND

Abdominal sepsis frequently leads to disseminated intravascular coagulation (DIC), exacerbating organ dysfunction and bleeding complications. Although anticoagulant therapy is a potential treatment for DIC, its use in this context raises concerns about bleeding risks.

OBJECTIVES

The purpose of this study is to investigate the risks and benefits of DIC-targeted anticoagulant therapy in patients with abdominal sepsis.

METHODS

Data were analyzed from a dataset from a multicenter nationwide retrospective cohort study (J-Septic DIC registry) in Japan between 2011 and 2013. The study included 987 patients with abdominal sepsis-induced DIC, diagnosed within three days of ICU admission. Patients were divided into DIC-targeted anticoagulant therapy (recombinant thrombomodulin or antithrombin) and non-use groups. Propensity score matching was used to adjust for confounding factors. The primary outcome was all-cause 90-day mortality, with bleeding complications requiring blood transfusion as the primary safety outcome.

RESULTS

The results indicated that anticoagulant therapy was associated with improved survival (hazard ratio: 0.662, 95 % confidential interval: 0.472-0.929), but a higher risk of bleeding complications (OR: 2.451, 95 % confidential interval:1.372-4.379). Dual combination of anticoagulant therapy did not provide additional survival benefits and increased bleeding risks. The efficacy of DIC-targeted anticoagulant therapy correlated with disease severity, while bleeding risk was inversely correlated with severity.

CONCLUSION

DIC-targeted anticoagulant therapy in patients with abdominal sepsis was related with improved prognosis but increased bleeding risks. The risk-benefit profile varies with disease severity, suggesting a need for cautious and personalized treatment strategies.