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Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery

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Abstract

Purpose

To describe outcome and changes in clotting and inflammatory parameters in an uncontrolled case series of consecutive patients with severe sepsis who received protein C concentrate soon after cardiac surgery.

Methods

From January 2007 to January 2008 nine consecutive adult patients with severe sepsis or septic shock and two or more organ failure after cardiac surgery received protein C concentrate, 50 IU/kg as a bolus followed by continuous infusion of 3 IU/kg per hour for 72 h.

Results

The increase in protein C levels was accompanied by an early drop in interleukins and near-normalization of prothrombin time, activated partial thromboplastin time, antithrombin and thrombin–antithrombin complex levels (p ≤ 0.03). No patient experienced drug-related side effects. Thirty-day mortality was 11% (1 patient) compared to the expected mortality of 68%.

Conclusions

In this pilot, uncontrolled study of nine patients with sepsis-induced double organ failure following cardiac surgery, treatment with protein C concentrate was associated with significant improvement in clinical, inflammatory and clotting parameters, no bleeding and low 30-day mortality.

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Acknowledgments

We thank Dr. Charles and Naomi Esmon for their kind gift of the monoclonal antibody HAPC-1555. We are also indebted to Mariano Fichera, RN, Isotta Virzo, RN, Cristiano Chiappa, RN, Giuseppe Giardina, RN, and Giulio Cozzuto, RN, for their appreciated contribution to this work.

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Authors and Affiliations

  1. Department of Cardiac Anesthesia and Intensive Care, Università Vita-Salute San Raffaele, Via Olgettina 60 Milano, Milan, 20132, Italy

    Martina Crivellari, Giovanni Landoni, Federico Pappalardo, Chiara Gerli, Elena Bignami, Giovanni Marino & Alberto Zangrillo

  2. Coagulation Service and Thrombosis Research Unit, Università Vita-Salute San Raffaele, Milan, Italy

    Patrizia Della Valle & Armando D’Angelo

Authors
  1. Martina Crivellari
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  2. Patrizia Della Valle
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  3. Giovanni Landoni
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  4. Federico Pappalardo
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  5. Chiara Gerli
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  6. Elena Bignami
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  7. Giovanni Marino
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  8. Alberto Zangrillo
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  9. Armando D’Angelo
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Corresponding author

Correspondence to Giovanni Landoni.

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Crivellari, M., Della Valle, P., Landoni, G. et al. Human protein C zymogen concentrate in patients with severe sepsis and multiple organ failure after adult cardiac surgery. Intensive Care Med 35, 1959–1963 (2009). https://doi.org/10.1007/s00134-009-1584-3

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  • DOI: https://doi.org/10.1007/s00134-009-1584-3

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