{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T17:23:39Z","timestamp":1776533019086,"version":"3.51.2"},"reference-count":21,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,6,8]],"date-time":"2021-06-08T00:00:00Z","timestamp":1623110400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background and Aim<\/jats:title><jats:p>Recombinant thrombomodulin (rhTM) is potentially effective in the treatment of disseminated intravascular coagulation (DIC). Several studies related to drugs for the treatment of acute cholangitis have shown negative results in improvement of overall survival (OS) with rhTM. The aim of this multicenter study was to evaluate the clinical effectiveness of rhTM in patients with acute cholangitis and sepsis\u2010induced DIC who underwent biliary drainage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A total of 284 consecutive patients, who were complicated with sepsis\u2010induced DIC due to severe acute cholangitis, were included (rhTM group, n\u00a0=\u00a0173; non\u2010rhTM, n\u00a0=\u00a0111) in this study. The primary outcome was the DIC resolution rate at 7\u00a0days after starting treatment. The 28\u2010day survival rate was secondarily evaluated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>DIC scores in the rhTM group improved significantly compared with the non\u2010rhTM group on day 7 (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.020). According to multivariate analysis, etiology of cholangitis (malignant, HR 2.28), rhTM (non\u2010administration, HR 4.13), and DIC score (\u22655, HR 2.46) were significant factors associated with failed DIC resolution on day 7. Propensity score matching created 103 matched pairs. Survival rate at day 28 was significantly higher in rhTM group (94.3%) compared with non\u2010rhTM group (82.6%; <jats:italic>P<\/jats:italic>\u00a0=\u00a0.048) after propensity score matching. rhTM (non\u2010administration, HR 2.870), DIC score (\u22655, HR 2.751), and APACHE II score (\u226520, HR 9.310) were significant factors associated with decreasing survival rate at day 28.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, rhTM seemed to improve patient survival, but future studies should only include patients with benign or malignant disease and should be performed according to APACHE II scores.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jhbp.998","type":"journal-article","created":{"date-parts":[[2021,5,22]],"date-time":"2021-05-22T11:21:01Z","timestamp":1621682461000},"page":"221-228","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Clinical impact of recombinant thrombomodulin administration on disseminated intravascular coagulation due to severe acute cholangitis (Recover\u2010AC study)"],"prefix":"10.1002","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2916-6568","authenticated-orcid":false,"given":"Takeshi","family":"Ogura","sequence":"first","affiliation":[{"name":"Department of Internal Medicine Osaka Medical College  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9026-4808","authenticated-orcid":false,"given":"Takaaki","family":"Eguchi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Osaka Saiseikai Nakatsu Hospital  Osaka Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0915-030X","authenticated-orcid":false,"given":"Kazunari","family":"Nakahara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology St. Marianna University School of Medicine  Kawasaki Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshihide","family":"Kanno","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Sendai City Medical Center  Sendai Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsuke","family":"Omoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine  Osakasayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masahiro","family":"Itonaga","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine Wakayama Medical University  Wakayama Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taira","family":"Kuroda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Hepatology Ehime University Graduate School of Medicine  Toon 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