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  • Title: Early suspension of activated protein C treatment in septic patients after shock reversal.
    Author: Pestaña D, Ramos R.
    Journal: Eur J Anaesthesiol; 2009 Dec; 26(12):1072-5. PubMed ID: 19474736.
    Abstract:
    BACKGROUND AND OBJECTIVE: After observing that the interruption of activated protein C (aPC) treatment after septic shock reversal was not associated with any deleterious effect, we started to suspend the treatment whenever vasopressors were no longer required. We present a report of our data. METHODS: We studied retrospectively a 3-year septic shock database that included 157 patients from a surgical ICU in a university hospital. aPC was considered to be indicated in 111 cases. We analysed data from 20 surgical patients with septic shock in whom aPC treatment was suspended before 96 h due to noradrenaline withdrawal (NA-). These patients were compared with a group of patients in whom aPC was suspended for coagulation disorders or surgical reasons while still receiving vasopressor treatment (NA+, n = 11), with patients not treated with aPC, although presenting criteria for its use (aPC-, n = 31) and with patients receiving the standard protocol for 96 h (aPC+, n = 49). RESULTS: No differences in age, sex, severity scores or source of infection were found between groups. Noradrenaline was not required by any NA- patient within 24 h after aPC withdrawal. A statistically nonsignificant trend to a lower mortality was observed in the NA- patients [4/20 (20%) vs. 5/11 (46%) in NA+, 18/31 (58.1%) in aPC- and 22/49 (45%) in aPC+ patients, P = 0.066]. CONCLUSION: The use of aPC should be considered in septic shock, but its suspension after shock reversal in this small series of patients was not associated with any deleterious effect.
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