Comparison of Danaparoid Sodium and Synthetic Protease Inhibitors for the Treatment of Disseminated Intravascular Coagulation Associated with Hematological Malignancies: A Retrospective Analysis

Acta Haematol. 2020;143(3):250-259. doi: 10.1159/000501818. Epub 2019 Aug 28.

Abstract

Background: Danaparoid sodium and synthetic protease inhibitors (SPIs) have been approved for the treatment of disseminated intravascular coagulation (DIC) in Japan.

Objectives: To compare the clinical results of the treatment of DIC with danaparoid or SPIs.

Methods: We retrospectively examined 188 patients with hematological malignancy-related DIC.

Results: DIC resolution rate in the danaparoid group was higher than that in the SPIs group (61.5 vs. 42.6%; p = 0.031) on day 7. Multivariate analysis identified the response to chemotherapy as independent predictive factor for DIC resolution on day 7 (odds ratio, OR, 2.28; 95% confidence interval, CI, 1.21-4.31; p = 0.011). While there was no significant difference in the DIC resolution rate on day 14 (75.0 vs. 62.4%; p = 0.117), in a subgroup analysis of patients who did not show an improvement in the underlying disease, the danaparoid group showed a significantly better DIC resolution rate (OR 3.89; 95% CI 1.15-13.2; p = 0.030). There was no difference in the rate of cumulative mortality from bleeding within 28 days between the 2 groups (6.6 vs. 3.3%; p = 0.278).

Conclusions: Danaparoid may be associated with more frequent resolution of DIC in patients with refractory underlying disease.

Keywords: Danaparoid sodium; Disseminated intravascular coagulation; Gabexate mesilate; Hematological malignancy; Nafamostat mesilate; Synthetic protease inhibitors.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Blood Component Transfusion
  • Chondroitin Sulfates / adverse effects
  • Chondroitin Sulfates / therapeutic use*
  • Dermatan Sulfate / adverse effects
  • Dermatan Sulfate / therapeutic use*
  • Disseminated Intravascular Coagulation / drug therapy
  • Disseminated Intravascular Coagulation / therapy
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Fibrinogen / analysis
  • Hematologic Neoplasms / blood*
  • Hematologic Neoplasms / drug therapy
  • Hemorrhage / etiology
  • Hemorrhage / mortality
  • Heparitin Sulfate / adverse effects
  • Heparitin Sulfate / therapeutic use*
  • Humans
  • Male
  • Middle Aged
  • Plasma
  • Protease Inhibitors / adverse effects
  • Protease Inhibitors / therapeutic use*
  • Prothrombin Time
  • Retrospective Studies
  • Treatment Outcome

Substances

  • Fibrin Fibrinogen Degradation Products
  • Protease Inhibitors
  • fibrin fragment D
  • Dermatan Sulfate
  • Fibrinogen
  • Chondroitin Sulfates
  • Heparitin Sulfate
  • danaparoid