A Retrospective Observational Study on the Administration Duration of Recombinant Human Soluble Thrombomodulin in Patients with Infection-induced Disseminated Intravascular Coagulation

We retrospectively studied recombinant human soluble thrombomodulin (rTM) administration duration and survival rate and the clinical factors affecting rTM administration duration in patients with infection-induced disseminated intravascular coagulation (DIC). We included patients with infection-induced DIC at Kushiro City General Hospital who met the Japanese Association for Acute Medicine DIC criteria and received rTM between April 2014 and March 2018. Sixty-four patients were categorized into two groups according to rTM administration duration: administration within six days (n = 49) and administration over seven days (n = 15). The 28-day survival rate of the two groups, stratified by rTM administration duration, was compared using Kaplan-Meier analysis to investigate the association between rTM administration duration and survival rate. Multiple regression analysis was used to examine clinical factors affecting rTM administration duration. There was no significant association between rTM administration duration and survival rate (P = 0.549). but a combination of immunoglobulins was significantly associated with prolonged rTM administration duration (P < 0.01). Furthermore, a higher white blood cell (WBC) count and higher creatinine clearance (CCr) were significantly associated with a shorter rTM administration duration (P < 0.01 and P = 0.023, respectively). Given the high cost, an rTM administration duration of within six days may be an option. Additionally, a higher WBC count or higher CCr before rTM administration is expected to shorten rTM administration duration. Because of the small sample size and single-center retrospective observational design of this study, a multicenter prospective study is needed to robustly validate our results.