Effect of Thrombomodulin Alfa on Disseminated Intravascular Coagulation in Patients with Lung Cancer

Objective The mortality rate due to disseminated intravascular coagulation (DIC) is higher in patients with lung cancer than in those without. We examined the effect of treatment with thrombomodulin alfa (TM-alpha) for DIC in lung cancer patients. Methods Subjects were 57 patients with DIC (43 men, 14 women; mean age, 71.7 years), comprising 31 with lung cancer and 26 without. DIC patients with or without lung cancer did not differ significantly in their background characteristics. Results No significant difference was noted in the mortality rate between patients with lung cancer (61.3%) and those without (57.7%). However, the dose of TM-a was higher for survivors with lung cancer than for non-survivors (473.1 U/kg/day vs. 380.6 U/kg/day; p<0.01). Although no significant difference was noted in the DIC score between these four groups, the serum C-reactive protein level (6.9 mg/dL vs. 11.6 mg/dL; p< 0.05) and prothrombin time-international normalized ratio (PT-INR; 1.10 vs. 1.52; p< 0.05) were lower in survivors with lung cancer than in the non-survivors with lung cancer. The initial body temperature in nonsurvivors without lung cancer was lower than that in survivors without lung cancer (37.2 degrees C vs. 37.9 degrees C, p< 0.01), and the platelet count and the time to recovery from DIC in patients without lung cancer showed a significant negative correlation (r(2)= 0.438, p< 0.05). Conclusion Our findings suggest that although 380 U/kg/day of TM-a is the recommended dose for DIC treatment, a higher dose may reduce the mortality rate of lung cancer patients with DIC. Furthermore, TM-a should be initiated before worsening of DIC parameters.