2014 年 8 巻 1-2 号 p. 17-23
It remains unclear whether longer-term use of recombinant human soluble thrombomodulin (rhs-TM) enhances outcomes in patients with disseminated intravascular coagulation (DIC). This study investigated whether longer use of rhs-TM influenced outcomes in patients with DIC based on a national administrative database. Between 2010 and 2012, 6,354 patients with DIC were treated with rhs-TM at 735 hospitals in Japan. Patients were divided into two groups according to duration of use of rhs-TM: < 7 days (n = 4,685) and ≥ 7 days (n = 1,669). The in-hospital mortality rate, length of stay (LOS) and medical costs during hospitalization in these two groups were compared. Overall mortality rates were similar in the (odds ratio 1.05; 95% confidence interval (CI): 0.93 – 1.19, p = 0.358). LOS was significantly longer and medical costs during hospitalization significantly higher in patients treated with rhs-TM for ≥ 7 than < 7 days. The unstandardized coefficient for LOS was 15.97 days (95% CI, 13.77 – 18.16 days; p < 0.001) whereas that for medical costs during hospitalization was 11650.5 US dollars (95% CI, 10350.0 – 12950.9 US dollars; p < 0.001). Longer treatment with rhs-TM did not affect the mortality rate of patients with DIC but significantly increased LOS and medical costs during hospitalization. Additional prospective studies are required to confirm the efficacy of longer treatment with rhs-TM for patients with DIC.