What is the role of recombinant thrombomodulin (rTM) in the treatment of disseminated intravascular coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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In Japan, rTM is widely used for treatment of DIC. Thrombomodulin binds with thrombin, and the resulting complex allows the conversion of protein C to APC. Additionally, thrombomodulin can also bind high-mobility group B (HBGM-1), which inhibits the inflammatory process. [77]

rTM has shown beneficial effects on DIC parameters and clinical outcome in initial trials. [92] It was evaluated in a randomized controlled study involving 234 subjects and was found to yield significantly improved control of DIC in comparison with unfractionated heparin, particularly with respect to the control of persistent bleeding diathesis. [93]

However, a meta-analysis by Zhang et al found that in patients with infection complicated by DIC, treatment with rTM does not decrease short-term mortality: the risk ratio for 28- or 30-day mortality was 0.81 in randomized controlled trials and 0.96 in observational studies. [94]  In a systematic review and meta-analysis by Yamakawa et al of rTM for sepsis-induced DIC, pooled relative risk of 28-30 day mortality was 0.81 (95% CI, 0.62–1.06) in randomized controlled trials, indicating a non‐significant reduction in mortality, and 0.59 (95% CI, 0.45–0.77) in observational studies; results suggested that the probability of rTM therapy having a beneficial effect increases with increasing baseline risk. [95]

Inoue et al reported benefit with rTM treatment of DIC caused by noninfectious complications of allogeneic hematopoietic stem cell transplantation, such as acute graft-versus-host disease or thrombotic microangiopathy. In 12 episodes of DIC in 10 patients, the recovery rate was significantly higher than in historical controls. [96]

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