Antithrombin and mortality in severe pneumonia patients with sepsis‐associated disseminated intravascular coagulation: an observational nationwide study. (16th July 2014)

• Record Type: Journal Article
• Authors: Tagami, T.; Matsui, H.; Horiguchi, H.; Fushimi, K.; Yasunaga, H.
• Is Part Of: Journal of thrombosis and haemostasis. Volume 12:Number 9(2014:Sep.)
• Page Start: 1470
• Page End: 1479
• Publication Date: 2014-07-16
• Subjects: Thrombosis -- Periodicals; Hemostasis -- Periodicals; Blood coagulation disorders -- Periodicals; 616.1
• DOI: 10.1111/jth.12643
• Languages: English
• ISSNs: 1538-7933

Abstract

<abstract abstract-type="main" id="jth12643-abs-0001"> <title>Summary</title> <sec id="jth12643-sec-0001" sec-type="section"> <title>Background</title> <p>The association between antithrombin use and mortality in patients with sepsis‐associated disseminated intravascular coagulation (DIC) remains controversial.</p> </sec> <sec id="jth12643-sec-0002" sec-type="section"> <title>Objectives</title> <p>To examine the hypothesis that antithrombin could be effective in the treatment of patients with sepsis‐associated DIC following severe pneumonia.</p> </sec> <sec id="jth12643-sec-0003" sec-type="section"> <title>Methods</title> <p>Propensity score and instrumental variable analyses were performed by use of a nationwide administrative database, the Japanese Diagnosis Procedure Combination inpatient database. The main outcome was 28‐day mortality.</p> </sec> <sec id="jth12643-sec-0004" sec-type="section"> <title>Results</title> <p>Severe pneumonia patients diagnosed with sepsis‐associated DIC (<italic>n</italic> = 9075) were categorized into antithrombin (<italic>n</italic> = 2663) and control (<italic>n</italic> = 6412) groups. Propensity score matching created a matched cohort of 2194 pairs of patients with and without antithrombin use. Mortality differences were found between the two groups (antithrombin vs. control: unmatched, 40.8% vs. 45.7%; propensity‐matched, 40.6% vs. 44.2%; inverse probability‐weighted, 41.1% vs. 45.1%). Multiple logistic regression analyses showed an association between antithrombin use and 28‐day mortality (unmatched with propensity score adjusted, adjusted odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78–0.97; propensity‐matched, adjusted OR 0.85, 95% CI 0.75–0.97; inverse probability‐weighted, adjusted OR 0.85, 95% CI 0.79–0.90). An analysis with the hospital antithrombin‐prescribing rate as an instrumental variable showed that receipt of antithrombin was associated with a 9.9% (95% CI 3.5–16.3) reduction in 28‐day mortality.</p> </sec> <sec id="jth12643-sec-0005" sec-type="section"> <title>Conclusions</title> <p>This retrospective, large, nationwide database study demonstrates that antithrombin administration may be associated with reduced 28‐day mortality in patients with severe pneumonia and sepsis‐associated DIC. A large, multinational randomized trial is required.</p> </sec> </abstract>