Background Goal of study:
It is unclear whether anticoagulant treatment is necessary for sepsis or infection-induced disseminated intravascular coagulation(DIC) Therefore, we performed a network meta-analysis to evaluate the effects of various anticoagulant treatments and placebo treatment for patients with sepsis- or infection-induced DIC.
Materials and Methods:
We searched the PubMed, MEDLINE, and Cochrane for other studies that investigated anticoagulant treatment for sepsis- or infection-induced DIC using antithrombin Ⅲ, thrombomodulin, heparin, or protease inhibitors. The primary outcome was mortality, and the secondary outcomes were the rate of DIC resolution and the risk of bleeding complications. The network meta-analysis was performed within a Bayesian framework meta-analysis provided a rank probability for each anticoagulant treatments and placebo and outcomes.
Results and discussion
The network meta-analysis included 1340 patients from 9 studies . There were no significant differences in the risks of mortality and bleeding complications among all direct comparisons and the network meta-analysis. Placebo treatment was associated with a significantly lower rate of DIC resolution , compared to antithrombin treatment in the direct comparsion(odds ration[OR]:0.20,95% credible interval[95% Crl]:0.046-0.81)and in the network meta-analysis(OR:0.20,95% CrI:0.043-0.84).The rank probabilities suggested that heparin had a 46.0% probability of being the worst treatment for reducing in-hospital mortality and a 95.2% probability of being the worst treatment for reducing the risk of bleeding complications.
Conclusion
The present study revealed no significant difference in the risks of mortality and bleeding complications for all comparisons of the four anticoagulant treatments and the placebo treatment. However, antithrombin treatment might be superior to placebo treatment in resolving sepsis- or infection-induced DIC. Nevertheless, only 9 randomized controlled trials were eligible for the present study, which indicates that further studies are needed to validate our finfings.


01 / A network meta-analysis of anticoagulant treatment for sepsis- or infection-induced disseminated intravascular coagulation