Taniguchi Kohei, Ohbe Hiroyuki, Yamakawa Kazuma, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Translational Research Program, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
BMC Cancer. 2020 Sep 9;20(1):867. doi: 10.1186/s12885-020-07375-2.
Terminal-stage solid tumors are one of the main causes of disseminated intravascular coagulation (DIC); effective therapeutic strategies are therefore warranted. This study aimed to investigate the association between mortality and antithrombin therapy in patients with stage IV solid tumor-associated DIC using a large nationwide inpatient database.
From July 2010 to March 2018, patients with stage IV solid tumor-associated DIC in the general wards, intensive care unit, or high care unit were identified using the Japanese Diagnosis Procedure Combination Inpatient Database. Patients who received antithrombin within 3 days of admission were allocated to the antithrombin group, while the remaining patients were allocated to the control group. One-to-four propensity score matching analyses were applied to compare outcomes. The primary outcome was the 28-day in-hospital mortality.
Of the 25,299 eligible patients, 919 patients had received antithrombin within 3 days of admission and were matched with 3676 patients in the control group. There were no significant differences in the 28-day mortality between the two groups (control vs. antithrombin: 28.9% vs. 30.3%; hazard ratio, 1.08; 95% confidence interval, 0.95-1.23). There were no significant differences in the organ failure score and the proportion of critical bleeding between the two groups. Subgroup analyses showed that the effects of antithrombin were not significantly different among different tumor types.
Using a nationwide Japanese inpatient database, this study showed that there is no association between antithrombin administration and 28-day mortality in patients with stage IV solid tumor-associated DIC. Therefore, establishing other therapeutic strategies for solid tumor-associated DIC is required.
终末期实体瘤是弥散性血管内凝血（DIC）的主要原因之一；因此，需要有效的治疗策略。本研究旨在利用一个大型全国住院患者数据库，调查IV期实体瘤相关性DIC患者的死亡率与抗凝血酶治疗之间的关联。
2010年7月至2018年3月，利用日本诊断程序组合住院患者数据库，识别普通病房、重症监护病房或高级护理病房中IV期实体瘤相关性DIC患者。入院3天内接受抗凝血酶治疗的患者被分配到抗凝血酶组，其余患者被分配到对照组。应用1对4倾向评分匹配分析来比较结果。主要结局是28天院内死亡率。
在25299例符合条件的患者中，919例患者在入院3天内接受了抗凝血酶治疗，并与对照组的3676例患者进行了匹配。两组之间的28天死亡率无显著差异（对照组与抗凝血酶组：28.9%对30.3%；风险比，1.08；95%置信区间，0.95-1.23）。两组之间的器官衰竭评分和严重出血比例无显著差异。亚组分析表明，不同肿瘤类型之间抗凝血酶的效果无显著差异。
本研究利用日本全国住院患者数据库表明，IV期实体瘤相关性DIC患者使用抗凝血酶与28天死亡率之间无关联。因此，需要为实体瘤相关性DIC建立其他治疗策略。
