1,416 research outputs found
Antithrombin supplementation and risk of bleeding in patients with sepsis-associated disseminated intravascular coagulation
No full textINTRODUCTION:
Although antithrombin is commonly used for the treatment of sepsis-associated disseminated intravascular coagulation (DIC) in Japan, the factors influencing the incidence of bleeding complications have not been sufficiently studied. The purpose of this survey was to identify the factors that predict clinically relevant bleeding in patients receiving antithrombin for DIC.
METHODS:
We analyzed data from 1026 sepsis-associated DIC patients with a baseline antithrombin activity ≤70% who underwent antithrombin supplementation at two dosages (1500IU/day or 3000IU/day) for three consecutive days. The patients' demographic characteristics, parameters before and after the treatment, and co-administered anticoagulants were analyzed in relation to the bleeding events.
RESULTS:
Overall, 55 patients (5.36%) experienced bleeding events (major bleeding: 1.75%). Logistic regression analysis revealed that sustained DIC>7days was significantly associated with bleeding (odds ratio: 2.761, P=0.001). In contrast, the higher dose of antithrombin or the co-administration of recombinant thrombomodulin or heparins were not associated with bleeding events.
CONCLUSION:
A higher dose of antithrombin or the concomitant use of other anticoagulants were not associated with bleeding events. On the other hand, sustained DIC lasting more than one week was associated with an increased risk of bleeding in patients with sepsis-associated DIC
Newly Proposed Sepsis-Induced Coagulopathy Precedes International Society on Thrombosis and Haemostasis Overt-Disseminated Intravascular Coagulation and Predicts High Mortality
No full textBackground: Disseminated intravascular coagulation (DIC) has been recognized as an urgent and critical condition in patients with sepsis. Therefore, unfamiliar and time-consuming tests or a complex scoring system are not suitable for diagnosis. Sepsis-induced coagulopathy (SIC), a newly proposed category delineated by a few global coagulation tests, has been established as an early warning sign for DIC. The purpose of this study was to elucidate the characteristics of SIC, especially in relation to the score of the International Society on Thrombosis and Haemostasis (ISTH) for overt DIC. Method: A data set for 332 patients with sepsis who were suspected to have DIC, antithrombin activity <70%, and treated with antithrombin substitution was utilized to examine the relationship between SIC and overt DIC. The performance of SIC calculated at baseline (ie, before treatment) as well as on days 2, 4, or 7 was analyzed in terms of its ability to predict 28-day mortality and overt DIC. Results: At baseline, 149 (98.7%) of 151 patients with overt DIC according to the ISTH definition were diagnosed as having SIC. Of the 49, 46 (93.9%) patients who developed overt DIC between days 2 and 4 had received a prior diagnosis of SIC. The sensitivity of baseline SIC for the prediction of death was significantly higher than that of overt DIC (86.8% vs 64.5%, P < .001). The sensitivity of SIC on days 2, 4, and 7 was significantly higher than those of overt DIC (96.1%, 92.3%, and 84.4% vs 67.1%, 57.7%, and 50.0%, P < .001, .001, and .001, respectively), although the specificity of SIC was lower at all time points. </jats:sec
The Administration of Ciprofloxacin During Continuous Renal Replacement Therapy : Pilot Study
No full textContinuous renal replacement therapy (CRRT) is a common technique in critically ill patients. However, there is no uniformity in the pharmacokinetics of ciprofloxacin (CPFX) used during CRRT. The aims of the present study were to estimate the pharmacokinetics of CPFX and to determine the appropriate administration of CPFX for critically ill patients undergoing CRRT. CPFX total clearance (CLtot) was calculated based on the creatinine clearance (CLcre), dialysate flow (QD) and ultrafiltrate flow (QF) as follow: CL_[tot (l/h)] = (4.83 CL_[cre (l/h)] + 6.41) + 0.92 (QD+Q_[F (l/h)]) base on in vitro study using CRRT circuit model. We administered CPFX to critically ill patients based on the CLtot, which was 50 x CL_[tot (l/h)] (mg/day). We confirmed that the CPFX concentrations reached higher than optimal concentrations and the infections were all successfully controlled in these patients
A successful model of regional healthcare information exchange in Japan: Case Study in Kagawa Prefecture
No full textIn this study, we focused on analysis of healthcare data exchange over the network. For the advance of broadband capability development, many governments expect online medical information exchange between medical institutions. Japanese government also has tried to deploy ICT in the healthcare field. In Japan, many healthcare ICT projects started, but almost of all the projects face many issues and failed to continue. This situation caused us to clarify the success factor of healthcare information exchange network. For inspecting the success factors, we analyzed information access of healthcare systems in Kagawa prefecture of Japan. Kagawa prefecture is one of the most advance areas for healthcare information technology. We analyzed four medical ICT projects in Kagawa prefecture: K-MIX, Critical Pathway for Diabetes, E-prescription, and PHR. In addition, we inspected characteristics of exchanged data in the network, and stakeholder involved in these projects. This analysis lets us find various types of healthcare ICT projects. Characteristic of data processed in the projects caused differences of characteristic of the projects. On the other hand, multiple systems process same data, though the project does not share the data itself. Considering various types of medical information exchanges projects, we propose classification and standard format of exchanged data according to their characteristic are critical for efficient business deployment. --e-Health,regional healthcare information exchange,EHR
Analysis for science librarians of the 2015 Nobel Prize in Physiology or Medicine: the life and work of William C. Campbell, Satoshi Ōmura, and Youyou Tu
No full textParasites affect humans worldwide with varying degrees of seriousness. Some of the most impactful parasitic infections affect millions of people, many of whom are already impoverished and struggling. The discoveries of the 2015 Nobel Laureates in Physiology of Medicine have changed the way some of these serious parasitic infections are treated, saving and improving the lives of countless people. These Laureates are William C. Campbell, Satoshi Ōmura, and Youyou Tu
A Prospective Comparative Study of Three Sets of Criteria for Disseminated Intravascular Coagulation : ISTH Criteria vs Japanese Criteria
No full textClinical and laboratory criteria and a scoring system for disseminated intravascular coagulation (DIC) were recently published by the International Society on Thrombosis and Haemostasis (ISTH). In Japan, the DIC Diagnostic Standards published in 1988 have been widely used for more than 10 years. In a general intensive care unit, we prospectively compared the diagnostic properties of the overt DIC, non-overt DIC, and Japanese DIC criteria sets, and investigated the influences of each set on patient morbidity and mortality. Seventy-four patients with platelet counts below 150 x 10^9/L were included in this study. Blood samples were collected daily from day 0 to day 4 after inclusion in the study. The Japanese DIC included the overt DIC and both of these were included in the non-overt DIC. The Japanese DIC criteria diagnosed DIC earlier than the non-overt DIC criteria did (p = 0.020). The DIC patients diagnosed by the Japanese criteria and those diagnosed by the overt DIC criteria showed a higher incidence of multiple organ failure than those without DIC (p = 0.013 and p = 0.022, respectively). The Japanese and the non-overt DIC criteria tended to predict patient prognoses effectively. In conclusion, the Japanese and the non-overt DIC criteria are of value in predicting outcome. However, the non-overt DIC criteria take more time to diagnose DIC than the Japanese criteria do. A more precise clinical study is needed to determined appropriate specific criteria and cut-ff points in the non-overt DIC criteria set
A Prospective Comparison of New Japanese Criteria for Disseminated Intravascular Coagulation : New Japanese Criteria Versus ISTH Criteria
No full textIn Japan, early diagnosis and early treatment of disseminated intravascular coagulation (DIC) based on the old Japanese criteria have greatly improved the outcomes of DIC patients with hematopoietic malignancy. However, the prognoses of critically ill patients with DIC have remained poor. To overcome this situation, new Japanese DIC criteria for critically ill patients were established in 2002. The new Japanese DIC criteria adopted a concept of coagulopathy associated with systemic inflammatory response syndrome. In the present study, we prospectively investigated the relationships between the new criteria and organ failure, prognosis, and other sets of DIC criteria. This study included 74 patients whose platelet counts were below 150 x 10^9/L. Daily DIC scores and sequential organ failure assessment scores were recorded from days 0 to 4 once the patient was included in the study. The new Japanese DIC criteria diagnosed DIC earlier than both the non-overt DIC and the old Japanese criteria did (p = 0.0005). The new Japanese criteria diagnosed more DIC patients prior to the establishment of multiple organ failure than the other sets (p = 0.023). The new Japanese criteria tended also to predict prognoses more efficiently than the other two sets. In conclusion, the diagnostic sensitivity of the new Japanese criteria was as high as that of the non-overt DIC criteria. Furthermore, the new Japanese criteria provided the earliest detection and most accurate outcome prediction of DIC among the DIC criteria sets
Recent advances in diagnosis and treatment of disseminated intravascular coagulation in sepsis and trauma
No full text
Thrombin you are! Relationship of coagulation cascade with inflammation reaction and organ damage
No full text- …
