Abstract
Background: The diagnostic criteria of acute-phase disseminated intravascular coagulation (DIC) were reported by the Japanese Association for Acute Medicine (JAAM) in 2005. The effectiveness of antithrombin III (AT-III) supplementation in septic shock patients diagnosed to have acute-phase DIC on the basis of the JAAM diagnostic criteria has not yet been reported. Objective: We examined the effectiveness of AT-III supplementation in septic shock cases with reference to the diagnosis of acute-phase DIC made on the basis of the JAAM criteria. Material and Methods: A retrospective analysis was performed of 32 septic shock patients who were admitted to our intensive care unit between July 2005 and February 2007 and were diagnosed to have DIC on the basis of the JAMM DIC criteria. The patients were divided into two groups for the analysis: the AT-III group (21 cases), in which the patients were treated with AT-III within 24 hours of the diagnosis of DIC, and the non AT-III group (11 cases), in which no AT-III treatment was administered. Results: There were no significant differences in the average Acute Physiology and Chronic Health Evaluation (APACHE) II score on admission or average Sepsis-related Organ Failure Assessment (SOFA) score at the time of a shock diagnosis between the two groups. The AT-III group tended to show a better survival rate (not significant difference; P = 0.0595), with significant improvement of the plasminogen activator inhibitor-1 (PAI-1) and protein C levels being observed. Conclusion: Early AT-III treatment after confirmation of DIC diagnosis by the JAAM DIC criteria would appear to be a useful strategy for the management of DIC-complicating septic shock.
