Thrombotic Microangiopathy‐Like Phenotype in Patients With Infection‐Associated Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa
12 affiliations
- 1Department of Hematology National Hospital Organization Disaster Medical Center Tokyo Japan
- 2Department of Hematology Nerima Hikarigaoka Hospital Tokyo Japan
- 3Medical Affairs Department Asahi Kasei Therapeutics Corporation Tokyo Japan
- 4Department of Hematology Fukushima Medical University Fukushima Japan
- 5Department of Internal Medicine Miyazaki Prefectural Miyazaki Hospital Miyazaki Japan
- 6Department of Laboratory Medicine National Hospital Organization Takasaki General Medical Center Takasaki Gunma Japan
- 7Higashi Kawaguchi Hospital Saitama Japan
- 8Department of Clinical Laboratory Medicine Tokyo Saiseikai Central Hospital Tokyo Japan
- 9Department of Emergency and Critical Care Medicine Mie University Graduate School of Medicine Tsu Mie Japan
- 10Department of Hematology Niigata University Medical and Dental Hospital Niigata Japan
- 11Department of Surgery, Center for Gastroenterology and Liver Disease Kitakyushu City Yahata Hospital Fukuoka Japan
- 12Department of General Medicine Mie Prefectural General Medical Center Yokkaichi Mie Japan
Abstract
Despite disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) sharing features of thrombocytopenia, organ dysfunction, and bleeding, the relationship between these two conditions remains unclear. We therefore conducted a post hoc analysis of post‐marketing surveillance data from Japan to evaluate the clinical characteristics of 2362 patients with DIC (TMA‐like phenotype DIC, n = 217; and non‐TMA‐like phenotype DIC, n = 2145) who received thrombomodulin alfa (TM‐α). TMA‐like phenotype DIC was defined as platelet count < 15 × 104/μL, hemoglobin < 10 g/dL and lactate dehydrogenase > 500 IU/L. Approximately 9% of the registered infection‐associated cases of DIC were TMA‐like phenotype DIC. Patients with TMA‐like phenotype were younger and had more renal dysfunction and liver dysfunction than those with non‐TMA‐like phenotype. Regarding the hemostatic examinations, fibrin/fibrinogen degradation products, d‐dimer, and thrombin‐antithrombin complex levels were higher in patients with TMA‐like phenotype than in those with non‐TMA‐like phenotype. Patients with TMA‐like phenotype had worse resolution of DIC and 28‐day survival rates than those with non‐TMA‐like phenotype; however, the coagulation and fibrinolysis parameters in both groups showed improvement after TM‐α administration. These findings describe a clinically severe subgroup of infection‐associated DIC and should be interpreted as exploratory given that confirmatory TMA testing was unavailable.
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BibTeX
@article{takezako2026thrombotic,
title = {{Thrombotic Microangiopathy‐Like Phenotype in Patients With Infection‐Associated Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa}},
author = {Naoki Takezako and Fumiyo Komatsu and Goichi Honda and Noriaki Kawano and Toshimasa Uchiyama and Kazuo Kawasugi and Seiji Madoiwa and Kei Suzuki and Yoshinobu Seki and Takayuki Ikezoe and Kohji Okamoto and Hideo Wada},
journal = {European Journal of Haematology},
year = {2026},
month = aug,
doi = {10.1111/ejh.70289},
url = {https://doi.org/10.1111/ejh.70289},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Thrombotic Microangiopathy‐Like Phenotype in Patients With Infection‐Associated Disseminated Intravascular Coagulation Treated With Thrombomodulin Alfa
AU - Naoki Takezako
AU - Fumiyo Komatsu
AU - Goichi Honda
AU - Noriaki Kawano
AU - Toshimasa Uchiyama
AU - Kazuo Kawasugi
AU - Seiji Madoiwa
AU - Kei Suzuki
AU - Yoshinobu Seki
AU - Takayuki Ikezoe
AU - Kohji Okamoto
AU - Hideo Wada
PY - 2026
DA - 2026/08/13
JO - European Journal of Haematology
DO - 10.1111/ejh.70289
UR - https://doi.org/10.1111/ejh.70289
AB - Despite disseminated intravascular coagulation (DIC) and thrombotic microangiopathy (TMA) sharing features of thrombocytopenia, organ dysfunction, and bleeding, the relationship between these two conditions remains unclear. We therefore conducted a post hoc analysis of post‐marketing surveillance data from Japan to evaluate the clinical characteristics of 2362 patients with DIC (TMA‐like phenotype DIC, n = 217; and non‐TMA‐like phenotype DIC, n = 2145) who received thrombomodulin alfa (TM‐α). TMA‐like phenotype DIC was defined as platelet count < 15 × 104/μL, hemoglobin < 10 g/dL and lactate dehydrogenase > 500 IU/L. Approximately 9% of the registered infection‐associated cases of DIC were TMA‐like phenotype DIC. Patients with TMA‐like phenotype were younger and had more renal dysfunction and liver dysfunction than those with non‐TMA‐like phenotype. Regarding the hemostatic examinations, fibrin/fibrinogen degradation products, d‐dimer, and thrombin‐antithrombin complex levels were higher in patients with TMA‐like phenotype than in those with non‐TMA‐like phenotype. Patients with TMA‐like phenotype had worse resolution of DIC and 28‐day survival rates than those with non‐TMA‐like phenotype; however, the coagulation and fibrinolysis parameters in both groups showed improvement after TM‐α administration. These findings describe a clinically severe subgroup of infection‐associated DIC and should be interpreted as exploratory given that confirmatory TMA testing was unavailable.
SN - 0902-4441
SN - 1600-0609
ER -