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

Hiroyuki Nagafuchi1, Yutaka Eguchi2, Toshiaki Ikeda3

  • 11 Department of Critical Care Medicine Kanagawa Children's Medical Center, Kanagawa, Minami-ku, Yokohama, Kanagawa, Japan.

Clinical and Applied Thrombosis/Hemostasis : Official Journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis
|March 7, 2019
PubMed

Insights

Antithrombin (AT) supplementation safely treats pediatric disseminated intravascular coagulation (DIC) in children. This therapy may improve DIC resolution, reduce organ failure, and lower mortality rates.

Area of Science:

  • Pediatric Hematology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Disseminated intravascular coagulation (DIC) is a life-threatening condition in children.
  • Current treatment guidelines for pediatric DIC require further evaluation for optimal outcomes.
  • Antithrombin (AT) supplementation is a potential therapeutic option for managing pediatric DIC.

Purpose of the Study:

  • To evaluate the efficacy and safety of antithrombin (AT) supplementation and anticoagulation in pediatric DIC.
  • To assess the impact of AT therapy on mortality, DIC resolution, and organ failure.
  • To determine optimal treatment thresholds based on disease severity scores.

Main Methods:

  • Retrospective analysis of 65 children meeting Japanese Ministry of Health and Welfare (JMHW) DIC criteria.
  • Evaluation of antithrombin concentrate and/or concomitant anticoagulants.
  • Primary endpoint: Standardized Mortality Ratio (SMR). Secondary endpoints: DIC resolution rate and pediatric sequential organ failure assessment (pSOFA) score.

Main Results:

  • The 28-day mortality rate was 6.8% with an SMR of 0.55.
  • The DIC resolution rate on day 3 was 54.5%.
  • Lower JMHW DIC scores (day 0) and pSOFA scores (day 3) were observed in patients with DIC resolution. A JMHW DIC score of 6 was identified as a potential cutoff.
  • No bleeding-related adverse events were reported with AT administration.

Conclusions:

  • Antithrombin supplementation and anticoagulation are safe initial treatments for pediatric DIC when the JMHW DIC score is 6.
  • This combined therapy may improve DIC resolution, reduce organ failure, and decrease mortality rates in children.
  • Further research is warranted to confirm these findings and optimize treatment protocols.

Keywords:
JAAM DIC criteriaJMHW DIC criteriaantithrombinchildrendisseminated intravascular coagulation

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