Thrombomodulin in disseminated intravascular coagulation and other critical conditions-a multi-faceted anticoagulant protein with therapeutic potential.
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Thrombomodulin plays a vital role in maintaining intravascular patency due to its anticoagulant, antiinflammatory, and cytoprotective properties. However, under pathological conditions such as sepsis and systemic inflammation, endothelial thrombomodulin expression is downregulated and its function impaired. As a result, administering thrombomodulin represents a potential therapeutic modality. Recently, the effect of recombinant thrombomodulin administration in sepsis-induced coagulopathy was evaluated in a randomized controlled study (SCARLET). A 2.6% 28-day absolute mortality reduction (26.8% vs. 29.4%) was reported in 800 patients studied that was not statistically significant; however, a post hoc analysis revealed a 5.4% absolute mortality reduction among the patients who fulfilled the entry criterion at baseline. The risk of bleeding did not increase compared to placebo control. Favorable effects of thrombomodulin administration have been reported not only in sepsis-induced coagulopathy but also in disseminated intravascular coagulations with various backgrounds. Interestingly, beneficial effects of recombinant thrombomodulin in respiratory, renal, and cardiovascular diseases might depend on its anti-inflammatory mechanisms. In this review, we summarize the accumulated knowledge of endogenous as well as recombinant thrombomodulin from basic to clinical aspects and suggest future directions for this novel therapeutic agent.
Disseminated intravascular coagulation (DIC)
Randomized controlled trial
Published Version (Please cite this version)10.1186/s13054-019-2552-0
Publication InfoLevy, Jerrold; Ito, Takashi; Thachil, Jecko; Asakura, Hidesaku; & Iba, Toshiaki (2019). Thrombomodulin in disseminated intravascular coagulation and other critical conditions-a multi-faceted anticoagulant protein with therapeutic potential. Critical care (London, England), 23(1). pp. 280. 10.1186/s13054-019-2552-0. Retrieved from https://hdl.handle.net/10161/19264.
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Professor of Anesthesiology
Major Research Interests Therapeutic strategies to prevent and treat bleeding Anticoagulation and reversal Hemostatic activation and mechanisms of thrombin generation Modulation of acute inflammatory responses Clinical applications of recombinant and purified protein concentrates Coagulopathy in critically ill patients Therapeutic approaches to shock and ventricular dysfunction Cardiovascular pharmacol