Effects of recombinant human activated protein C on the fibrinolytic system of patients undergoing conventional or tight glycemic control

F. Polli, M. Savioli, M. Cugno, R. Taccone, G. Bellani, R. Spanu, A. Pesenti, G. Iapichino, L. Gattinoni

Research output: Contribution to journalArticle

Abstract

Aim. Recombinant human activated protein C (rh-APC) and tight glycemic control (TGC) have been shown to reduce mortality in septic patients. Both interventions can reduce the plasma concentration and/or activity of the most powerful suppressor of fibrinolysis, plasminogen activator inhibitor-1 (PAI-I). Our aim was to evaluate the effects on the fibrinolytic system after the administration of rh-APC in septic patients undergoing conventional or TGC. Methods. Posthoc analysis of data was collected from 90 patients with severe sepsis/septic shock, randomized to either conventional or TGC groups. Independent of these treatments, patients with at least two organ dysfunctions simultaneously received rh-APC. Plasma levels of multiple biochemical markers for fibrinolysis, coagulation, and inflammation were determined every day for the 1st week and then on study days 9, 11,13, 18,23, and 28. Clinical data and sepsis-related organ failure assessment (SOFA) scores were also recorded. Results. Patients who had received rh-APC exhibited significantly more impairments in fibrinolysis at baseline (PAI-1 activity 49.76 [24.61-71.82] vs 21.92 [6.47-55-83] IU/mL, P=0.03). The reductions in plasma PAI-1 activity over time associated with rh-APC treatment were different according to whether the treatment was administered to patients undergoing conventional or TGC (P=0.01). However, the most prominent reductions were in patients undergoing conventional glycemic control. Significant interactions between the two study interventions were also found for PAI-1 concentration (P

Original languageEnglish
Pages (from-to)417-426
Number of pages10
JournalMinerva Anestesiologica
Volume75
Issue number7-8
Publication statusPublished - Jul 2009

Keywords

  • Blood glucose
  • Fibrinolysis
  • Plasminogen activator inhibitor 1
  • Recombinant human activated protein C
  • Sepsis
  • Shock, septic

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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    Polli, F., Savioli, M., Cugno, M., Taccone, R., Bellani, G., Spanu, R., Pesenti, A., Iapichino, G., & Gattinoni, L. (2009). Effects of recombinant human activated protein C on the fibrinolytic system of patients undergoing conventional or tight glycemic control. Minerva Anestesiologica, 75(7-8), 417-426.