Scribd Logo
Upload

Welcome to Scribd!

  • 342 views

    Sepsis and Activated Protein C How Does It Work?

    Uploaded by

    introvoyz041
    The document discusses activated protein C (APC) and its use for treating sepsis. APC works by acting as an anticoagulant, anti-inflammatory, and promoting fibrinolysis. A large clinical trial found that for patients meeting certain criteria for sepsis, treatment with APC reduced the mortality rate from 50% to 33%. However, APC also increased the risk of serious bleeding complications. The document outlines the inclusion and exclusion criteria for determining which sepsis patients should receive APC treatment based on the clinical trial results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Sepsis and Activated Protein C How Does It Work?

    Uploaded by

    introvoyz041
    342 views2 pages
    The document discusses activated protein C (APC) and its use for treating sepsis. APC works by acting as an anticoagulant, anti-inflammatory, and promoting fibrinolysis. A large clinical trial found that for patients meeting certain criteria for sepsis, treatment with APC reduced the mortality rate from 50% to 33%. However, APC also increased the risk of serious bleeding complications. The document outlines the inclusion and exclusion criteria for determining which sepsis patients should receive APC treatment based on the clinical trial results.

    Original Description:

    Sepsis

    Original Title

    Sepsis

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    The document discusses activated protein C (APC) and its use for treating sepsis. APC works by acting as an anticoagulant, anti-inflammatory, and promoting fibrinolysis. A large clinical trial found that for patients meeting certain criteria for sepsis, treatment with APC reduced the mortality rate from 50% to 33%. However, APC also increased the risk of serious bleeding complications. The document outlines the inclusion and exclusion criteria for determining which sepsis patients should receive APC treatment based on the clinical trial results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    342 views2 pages

    Sepsis and Activated Protein C How Does It Work?

    Uploaded by

    introvoyz041
    The document discusses activated protein C (APC) and its use for treating sepsis. APC works by acting as an anticoagulant, anti-inflammatory, and promoting fibrinolysis. A large clinical trial found that for patients meeting certain criteria for sepsis, treatment with APC reduced the mortality rate from 50% to 33%. However, APC also increased the risk of serious bleeding complications. The document outlines the inclusion and exclusion criteria for determining which sepsis patients should receive APC treatment based on the clinical trial results.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 2

    JVD 6/02

    SEPSIS AND ACTIVATED PROTEIN C


    HOW DOES IT WORK?

    Anti-coagulant: Inactivates factors Va and VIIIa, thus blocking thrombin generation.


    Anti-inflammatory: Indirectly decreased levels of thrombin decreases neutrophil recruitment
    and mast cell degranulation. . Directly (in vitro), inhibits neutrophil activation, cytokine
    production and E-selectin -mediated adhesion of cells to vascular endothelium.
    Pro-fibrinolysis: Inhibits PAI-1 thus promoting fibrinolysis.

    WHO SHOULD GET IT?


    Bernard et al. reported in NEJM (3/2002) the results of a large, multi-center, DBRCT of 1690
    patients randomized to receive drotrecogin alfa (APC) infusion vs. placebo for 96 hours.
    Inclusion criteria: sepsis due to known or suspected infection +
    SIRS criteria T>38 or <36, HR>90, RR>20 or PaCO2 <32,
    WBC>12,000 or < 4,000 or >10% bands +
    1/5 end organ dysfunction SBP <90 or MAP <70 for one hour despite
    adequate fluid resuscitation, UOP< 0.5 ml/kg for 1 hour, PaO2/FIO2 <
    200, platelets < 80,000, metabolic acidosis pH< 7.30.
    Exclusion criteria: age < 18 or weight >135 kg, pregnancy
    Platelets < 30,000
    Conditions with increased risk of bleeding (recent/impending surgery
    within 12 hours, recent head trauma/stoke/surgery within 3 months, any
    hx of CNS mass/lesion/aneurysm, recent GI bleed within 6 weeks,
    congenital bleeding diathesis).
    Known hypercoaguable states, acute pancreatitis
    Comorbid medical conditions (cirrhosis with portal hypertension, HIV
    with CD4 < 50, s/p transplant, ESRD on HD/PD,
    Recent medication use of the following: heparin < 8 hours, warfarin < 7
    days, thrombolytics < 3 days, G2B3a antagonist < 7 days.

    SFGH Policy
    Inclusion criteria: as above
    Revised exclusion criteria: APACHE II score < 25, INR >3.0, active bleeding from
    any site, epidural catheter or spinal puncture within 12 hours; NOT NECESSARILY
    ESRD, AIDS, s/p Tx.
    Approval by critical care attending and fellow

    WHY DO IT?
    There is a clear mortality benefits in-patients with severe sepsis which when untreated caries a
    50 % mortality. RRR 19 %, ARR 6%, NNT 14.
    WHY NOT?
    Increased serious bleeding complications in APC group defined as any intracranial hemorrhage,
    any life threatening bleed or any bleed that required 3 or more PRBC transfusion on 2
    consecutive days.
    30 vs. 17 (3.5 % vs. 2.0)

    You might also like