Nagafuchi Hiroyuki, Eguchi Yutaka, Ikeda Toshiaki
1 Department of Critical Care Medicine Kanagawa Children's Medical Center, Kanagawa, Minami-ku, Yokohama, Kanagawa, Japan.
2 Department of Critical and Intensive Care Medicine, Shiga University of Medical Science, Shiga, Japan.
Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619834350. doi: 10.1177/1076029619834350.
We aimed to evaluate the efficacy and safety of antithrombin (AT) supplementation and concomitant anticoagulation therapy in 65 children who met the Japanese Ministry of Health and Welfare (JMHW) disseminated intravascular coagulation (DIC) criteria and had received AT concentrate and/or other concomitant anticoagulants. The primary efficacy end point was to determine standardized mortality ratio (SMR). The secondary efficacy end points were DIC resolution rate and pediatric sequential organ failure assessment (pSOFA) score on day 3. The 28-day mortality rate was 6.8%; SMR was 0.55. Disseminated intravascular coagulation resolution rate on day 3 was 54.5%. The JMHW DIC scores at day 0 ( P = .005) and pSOFA scores at day 3 ( P = .018) were significantly lower in patients with resolution of DIC than in those without resolution of DIC. The target cutoff value for JMHW DIC score on day 0 was 6. No bleeding-related adverse events were associated with AT administration. In children with DIC, AT supplementation and concomitant anticoagulation therapy can be safely used as initial treatment when JMHW DIC score is 6; it may improve DIC resolution, organ failure, and mortality rates.
我们旨在评估抗凝血酶（AT）补充治疗及联合抗凝治疗对65名符合日本厚生省（JMHW）弥散性血管内凝血（DIC）标准且已接受AT浓缩剂和/或其他联合抗凝剂治疗的儿童的疗效和安全性。主要疗效终点是确定标准化死亡率（SMR）。次要疗效终点是第3天的DIC缓解率和小儿序贯器官衰竭评估（pSOFA）评分。28天死亡率为6.8%；SMR为0.55。第3天的弥散性血管内凝血缓解率为54.5%。DIC缓解的患者第0天的JMHW DIC评分（P = 0.005）和第3天的pSOFA评分（P = 0.018）显著低于未缓解的患者。第0天JMHW DIC评分的目标临界值为6。AT给药未出现与出血相关的不良事件。在患有DIC的儿童中，当JMHW DIC评分为6时，AT补充治疗及联合抗凝治疗可安全地用作初始治疗；它可能会提高DIC缓解率、器官衰竭率和死亡率。
