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首页> 美国卫生研究院文献>Clinical and Applied Thrombosis/Hemostasis >Optimal Antithrombin Activity Threshold for Initiating Antithrombin Supplementation in Patients With Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study
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Optimal Antithrombin Activity Threshold for Initiating Antithrombin Supplementation in Patients With Sepsis-Induced Disseminated Intravascular Coagulation: A Multicenter Retrospective Observational Study

机译：脓毒症引起的弥散性血管内凝血患者中开始抗凝血酶补充的最佳抗凝血酶活性阈值：多中心回顾性观察研究

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Low-dose antithrombin supplementation therapy (1500 IU/d for 3 days) improves outcomes in patients with sepsis-induced disseminated intravascular coagulation (DIC). This retrospective study evaluated the optimal antithrombin activity threshold to initiate supplementation, and the effects of supplementation therapy in 1033 patients with sepsis-induced DIC whose antithrombin activity levels were measured upon admission to 42 intensive care units across Japan. Of the 509 patients who had received antithrombin supplementation therapy, in-hospital mortality was significantly reduced only in patients with very low antithrombin activity (≤43%; bottom quartile; adjusted hazard ratio: 0.603; 95% confidence interval: 0.368-0.988; P = .045). Similar associations were not observed in patients with low, moderate, or normal antithrombin activity levels. Supplementation therapy did not correlate with the incidence of bleeding requiring transfusion. The adjusted hazard ratios for in-hospital mortality increased gradually with antithrombin activity only when initial activity levels were very low to normal but plateaued thereafter. We conclude that antithrombin supplementation therapy in patients with sepsis-induced DIC and very low antithrombin activity may improve survival without increasing the risk of bleeding.
机译：小剂量抗凝血酶补充疗法（1500 IU / d，持续3天）可改善败血症诱导的弥散性血管内凝血（DIC）患者的预后。这项回顾性研究评估了开始补充的最佳抗凝血酶活性阈值，以及补充疗法对脓毒症诱发的DIC患者的影响，该患者在日本进入42个重症监护病房后测量了抗凝血酶活性水平。在接受抗凝血酶补充治疗的509名患者中，仅在抗凝血酶活性非常低的患者（≤43％；下四分位；危险比调整后：0.603； 95％置信区间：0.368-0.988； P）下，医院内死亡率才显着降低= .045）。抗凝血酶活性低，中或正常的患者未观察到类似的关联。补充疗法与需要输血的出血发生率无关。仅当初始活性水平非常低至正常水平但此后达到稳定水平时，抗凝血酶活性才使住院死亡率的调整后的危险比逐渐增加。我们得出的结论是，败血症诱导的DIC且抗凝血酶活性非常低的患者接受抗凝血酶补充疗法可以改善生存率，而不会增加出血的风险。

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