A Comparative Double-Blind Randomized Trial of Activated Protein C and Unfractionated Heparin in the Treatment of Disseminated Intravascular Coagulation
2002
A randomized prospective double-blind trial was performed to compare the safety and efficacy of human activated
protein C(APC) and unfractionated
heparinfor the treatment of
disseminated intravascular coagulation(DIC). One hundred thirty-two patients with DIC were enrolled in this study: 63 patients received APC (12.5 U [2.5 μg]/kg body wt per hour) and 69 patients received
heparin(8 U/kg body wt per hour) by intravenous infusion for 6 days. Forty-nine APC-treated patients and 55 heparintreated patients were evaluated for efficacy, and 52 APC-treated patients and 55
heparin-treated patients were evaluated for safety. The 2 groups were similar with respect to sex, age, body weight, underlying diseases, and coagulation/
fibrinolysisparameters before treatment. Aggravation of bleeding was seen after treatment in 8 patients receiving
heparin, but in none of the patients receiving APC. The number of patients who showed alleviation of bleeding was significantly higher in the APC group than the
heparingroup (P = .009). The effects on DIC-related organ dysfunction were not significantly different between the 2 groups. Fibrinogen-
fibrin degradation products,
D-dimer,
thrombin-antithrombin complex(TAT), and
plasmin-plasmininhibitor complex (PIC) were all significantly decreased by treatment in both groups. Fibrinogen,
protein C, and
antithrombinwere significantly increased in the APC group, whereas only
protein Cwas significantly increased in the
heparingroup. Platelet count in the nonleukemic group was significantly increased in those patients receiving APC but not increased in those patients receiving
heparin. Improvement of coagulation/
fibrinolysiswas assessed by scoring 4 parameters (soluble fibrin monomers,
D-dimer, TAT, and PIC), and the results indicated that the APC group showed significantly greater improvement than the
heparingroup (P = .046). There was, however, no significant difference in the rate of complete recovery from DIC between the 2 groups. The rate of death from any cause within 28 days after treatment was 20.4% in the APC group, significantly lower than the 40% death rate observed in the
heparingroup (P < .05). There were no severe adverse events in either group. These results suggest that APC in a relatively small dosage can improve DIC more efficiently than can
heparin, without increasing bleeding, and may be a better alternative.
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