Impact of Different Treatments for Disseminated Intravascular Coagulation on Patients with or without Biliary Drainage for Severe Biliary Tract Infection

Abstract

Makoto Kobayashi,1 Shun Takai,2 Kyohei Sakurai,3 Yoshimatsu Ehama3 1Director of Surgery and Intensive Care Center, Hakodate Goryokaku Hospital, Hakodate City, Hokkaido, Japan; 2Division of Gastroenterology, Hakodate Goryokaku Hospital, Hakodate City, Hokkaido, Japan; 3Division of Emergency Medicine, Hakodate Goryokaku Hospital, Hakodate City, Hokkaido, JapanCorrespondence: Makoto Kobayashi, Director of Surgery and Intensive Care Center, Hakodate Goryokaku Hospital, 38-3 Goryokaku-cho, Hakodate City, Hokkaido, 040-8611, Japan, Tel [phone], Fax [phone], Email [email protected]: Sepsis caused by severe acute cholangitis requires biliary drainage to decrease the intra-biliary pressure. Furthermore, several studies showed that anticoagulant treatment can improve the outcomes of patients with sepsis-associated disseminated intravascular coagulation (DIC). There were reports examining the efficacy of anti-DIC drugs in patients undergoing biliary drainage with sepsis-associated DIC, and no reports compared the efficacy of DIC treatments when no drainage is performed. In this study, the influence of antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparations on the overall survival (OS) of patients with and without biliary drainage was analyzed.Patients and Methods: This retrospective cohort study in a single institution involved patients with sepsis-associated DIC caused by severe biliary tract infection. In total, 71 patients treated by either AT replacement therapy or rTM preparation were assessed for inclusion. The two groups were patients with biliary drainage (n = 45) and without drainage (n = 26). To assess the clinical efficacy of anti-DIC drugs in each group, the 60-day OS was determined through estimated survival analysis.Results: Focusing on the effects of different therapeutic agents for DIC, in the group of patients with biliary drainage, OS showed no difference between patients treated by rTM and AT. However, in patients without biliary drainage, the survival curves of patients treated with AT replacement were lower than those of patients with rTM preparation.Conclusion: This study revealed that the OS of patients without biliary drainage differed depending on the DIC therapeutic agent for sepsis-associated DIC caused by acute cholangitis. We would recommend the use of rTM preparation over AT replacement therapy for patients who cannot undergo biliary drainage.Keywords: sepsis, antithrombin, recombinant thrombomodulin, DIC treatment, acute cholangitis

Keywords

• sepsis
• antithrombin
• recombinant thrombomodulin
• dic treatment
• acute cholangitis