Therapeutic advances in gastroenterology · 2025
Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute pancreatitis (Recover-AP study).
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Ogura Takeshi, Ueno Saori, Hakoda Akitoshi, Okuda Atsushi, Nishioka Nobu, Sakamoto Jun, Matsuno Jun, Uba Yuki, Tomita Mitsuki, Hattori Nobuhiro, Nakamura Junichi, Bessho Kimi, Iwatsubo Taro, Aboelezz Ahmad F, Nishikawa Hiroki
Аннотация
BACKGROUND: If severe acute pancreatitis (SAP) is complicated by disseminated intravascular coagulation (DIC) or walled-off necrosis (WON), the mortality rate may increase. Therefore, prevention of the development of WON and treatment of DIC are likely to play important roles in improving survival in SAP. Although recombinant human soluble thrombomodulin (rhTM) might play a useful role in treating DIC, the impact of rhTM on improving survival and resolution of DIC due to SAP is still unclear.
OBJECTIVE: This study aimed to evaluate the clinical impact of rhTM in patients with SAP and DIC.
DESIGN: A single-center retrospective study.
METHOD: The patients were divided into two groups: the rhTM group and the non-rhTM group, in which rhTM was not administered. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The mortality rate at 28 days was secondarily evaluated.
RESULTS: Among 321 SAP patients, 63 patients were complicated with DIC, and they were divided into rhTM (n = 28) and non-rhTM (n = 35) groups. The rate of development of WON was significantly higher in the non-rhTM group (51.4%, 18/35) compared with the rhTM group (25.0%, 7/28) (p = 0.033). The resolution rate of DIC within 7 days was significantly higher in the rhTM group (89.3%, 25/28) compared with the non-rhTM group (60.0%, n = 9/35) (p = 0.009). The mortality rate within 14 days, which might have been strongly influenced by the presence of DIC, was significantly higher in the non-rhTM group (20.0%, 7/35) compared with the rhTM group (0%, 0/28) (p = 0.01). According to multivariate analysis, rTM non-administration was an independent factor for failed DIC resolution or developing WON.
CONCLUSION: In conclusion, rhTM may play a role not only in improving the resolution rate of DIC and improving the survival rate of SAP, but also in preventing the development of WON.
OBJECTIVE: This study aimed to evaluate the clinical impact of rhTM in patients with SAP and DIC.
DESIGN: A single-center retrospective study.
METHOD: The patients were divided into two groups: the rhTM group and the non-rhTM group, in which rhTM was not administered. The primary outcome was the DIC resolution rate at 7 days after starting treatment. The mortality rate at 28 days was secondarily evaluated.
RESULTS: Among 321 SAP patients, 63 patients were complicated with DIC, and they were divided into rhTM (n = 28) and non-rhTM (n = 35) groups. The rate of development of WON was significantly higher in the non-rhTM group (51.4%, 18/35) compared with the rhTM group (25.0%, 7/28) (p = 0.033). The resolution rate of DIC within 7 days was significantly higher in the rhTM group (89.3%, 25/28) compared with the non-rhTM group (60.0%, n = 9/35) (p = 0.009). The mortality rate within 14 days, which might have been strongly influenced by the presence of DIC, was significantly higher in the non-rhTM group (20.0%, 7/35) compared with the rhTM group (0%, 0/28) (p = 0.01). According to multivariate analysis, rTM non-administration was an independent factor for failed DIC resolution or developing WON.
CONCLUSION: In conclusion, rhTM may play a role not only in improving the resolution rate of DIC and improving the survival rate of SAP, but also in preventing the development of WON.