Clinical and Applied Thrombosis/Hemostasis (Aug 2020)

Severe Antithrombin Deficiency May be Associated With a High Risk of Pathological Progression of DIC With Suppressed Fibrinolysis

  • Hideo Wada MD, PhD,
  • Goichi Honda PhD,
  • Noriaki Kawano MD, PhD,
  • Toshimasa Uchiyama MD, PhD,
  • Kazuo Kawasugi MD, PhD,
  • Seiji Madoiwa MD, PhD,
  • Naoki Takezako MD, PhD,
  • Kei Suzuki MD, PhD,
  • Yoshinobu Seki MD, PhD,
  • Takayuki Ikezoe MD, PhD,
  • Toshiaki Iba MD, PhD,
  • Kohji Okamoto MD, PhD

DOI
https://doi.org/10.1177/1076029620941112
Journal volume & issue
Vol. 26

Abstract

Read online

The frequency of severe antithrombin deficiency (SAD) was examined in the hematopoietic disorder-, infectious-, and basic-types of the disseminated intravascular coagulation (DIC). A posthoc analysis of 3008 DIC patients (infectious-type, 1794; hematological disorder-type, 813; and basic-type, 401) from post-marketing surveillance data of thrombomodulin alfa was performed. The clinical features of patients and outcomes were compared between patients with and without SAD, using an antithrombin cutoff value of 50%. Patients with SAD accounted for 40.4% of infectious-type DIC, 8.0% of hematopoietic disorder-type DIC, and 26.7% of basic-type DIC. There was no significant difference in thrombin–antithrombin complex levels between patients with and without SAD. The decreased fibrinogen level and differences in clinical features were significantly greater but the increases in fibrinolytic markers were significantly lower in patients with SAD than in those without. The 28-day survival rate was significantly lower in patients with SAD than in those without. Severe antithrombin deficiency was observed in all types of DIC, including hematopoietic disorders. Both hypofibrinolysis and hypercoagulability in patients with SAD may cause multiple organ failure and poor outcomes.