Current anticoagulation therapy for sepsis-induced disseminated intravascular coagulation in Japan: results of a multicenter study using administrative data

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Objective: Disseminated intravascular coagulation (DIC) is a serious complication associated with various underlying disorders, including sepsis. The aim of the current study was to investigate the status of therapy for patients with sepsis-induced DIC and to examine the association between 28-day mortality and use of anticoagulants. Methods: A multicenter cross-sectional study was performed from January 1, 2007 to December 31, 2008 in 45 ICUs in Japan. Using administrative data, 579 cases of sepsis-induced DIC were identified among patients who were admitted to an ICU, and these cases were used to assess the status of DIC therapy. The 28-day mortality was adjusted for the Critical care Outcome Prediction Equation (COPE) score, the Charlson comorbidity index and patient age, and associations with anticoagulants were then examined. Results: Protease inhibitors were used in 413 cases (71.3%), and antithrombin, unfractionated heparin, and low molecular weight heparin/danaparoid were used in 313 (54.1%), 385 (66.5%) and 201 (34.7%) cases, respectively. The overall 28-day mortality was 37%. In a Cox proportional hazards regression model, the hazard ratio (HR) of unfractionated heparin was 1.41, with a significant adverse effect on mortality (P=0.02). In a similar analysis, the HRs for protease inhibitors, antithrombin and low molecular weight heparin/danaparoid were 0.86, 0.90 and 0.88, respectively. These agents showed a tendency to reduce 28-day mortality, but the effect was not significant. Conclusions: A review of administrative data revealed that protease inhibitors were most frequently used in DIC anticoagulation therapy in ICUs in Japan. Unfractionated heparin was the only therapy to have a significant adverse effect on mortality.