Impact of Antithrombin Supplementation and Concomitant Anticoagulation Therapy in Pediatric Patients With Disseminated Intravascular Coagulation

Abstract

We aimed to evaluate the efficacy and safety of antithrombin (AT) supplementation and concomitant anticoagulation therapy in 65 children who met the Japanese Ministry of Health and Welfare (JMHW) disseminated intravascular coagulation (DIC) criteria and had received AT concentrate and/or other concomitant anticoagulants. The primary efficacy end point was to determine standardized mortality ratio (SMR). The secondary efficacy end points were DIC resolution rate and pediatric sequential organ failure assessment (pSOFA) score on day 3. The 28-day mortality rate was 6.8%; SMR was 0.55. Disseminated intravascular coagulation resolution rate on day 3 was 54.5%. The JMHW DIC scores at day 0 ( P = .005) and pSOFA scores at day 3 ( P = .018) were significantly lower in patients with resolution of DIC than in those without resolution of DIC. The target cutoff value for JMHW DIC score on day 0 was 6. No bleeding-related adverse events were associated with AT administration. In children with DIC, AT supplementation and concomitant anticoagulation therapy can be safely used as initial treatment when JMHW DIC score is 6; it may improve DIC resolution, organ failure, and mortality rates.

Keywords: JAAM DIC criteria; JMHW DIC criteria; antithrombin; children; disseminated intravascular coagulation.

Figure 1.

Flowchart of patients. AT indicates antithrombin; NM, nafamostat mesylate; rhTM, recombinant human thrombomodulin.

Figure 2.

Correlation between Japanese Ministry of Health and Welfare (JMHW) disseminated intravascular coagulation (DIC) score and Japanese Association for Acute Medicine (JAAM) DIC score. Both JMHW DIC and JAAM DIC scores on day 0 (open circle) and day 3 (closed circle) were plotted for 44 patients.