Efficacy and safety of anticoagulant therapy in three specific populations with sepsis: a meta-analysis of randomized controlled trials.
J Thromb Haemost. 2015 Dec 16;
Authors: Umemura Y, Yamakawa K, Ogura H, Yuhara H, Fujimi S
BACKGROUND: Although many preclinical trials have indicated the effectiveness and safety of anticoagulant therapy as an adjuvant therapy against sepsis, there is little evidence to support its effectiveness to reduce mortality in the overall population with sepsis in clinical situations. However, several studies suggested that specific anticoagulant therapy may potentially reduce mortality in patients with sepsis-induced disseminated intravascular coagulation (DIC).
OBJECTIVE: We investigated whether the survival benefit of anticoagulant therapy might pertain to the coagulopathic population with sepsis.
METHODS: We conducted separate meta-analyses of randomized controlled trials for anticoagulant therapy in three different populations: 1) overall population with sepsis, 2) population with sepsis-induced coagulopathy, and 3) population with sepsis-induced DIC. We searched MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials comparing anticoagulant therapy with placebo or no intervention in sepsis patients. We measured all-cause mortality as the primary outcome and bleeding complications as the secondary outcome.
RESULTS: We analyzed 24 trials enrolling 14,767 patients. There were no significant reductions in mortality in the overall sepsis population and the population with sepsis-induced coagulopathy. Otherwise, we observed significant reductions in mortality (RR 0.72, 95% confidence interval 0.62-0.85) in the population with sepsis-induced DIC. As adverse events, bleeding complications tended to increase similarly with anticoagulant therapy in all three populations.
CONCLUSION: Although associated with an increased risk of bleeding, anticoagulant therapy resulted in no survival benefits in the overall sepsis population and even the population with sepsis-induced coagulopathy; beneficial effects on mortality were observed only in the population with sepsis-induced DIC. This article is protected by copyright. All rights reserved.
PMID: 26670422 [PubMed - as supplied by publisher]