Antithrombin (AT) and Recombinant Human Thrombomodulin (rhTM) Combination as New Therapeutic Breakthrough in Managing Sepsis-Induced Coagulopathy (SIC)

Sepsis-induced coagulopathy (SIC) is a unique and urgent condition characterized by coagulation activation, overexpression of fibrinolysis, and high risk of organ dysfunction following sepsis. SIC is one of the complications of sepsis that is leading to a high mortality rate. Because there are no exact effective therapeutic agents specifically designed for SIC, new modalities are needed regarding the potential effect to suppress the mortality rate. Antithrombin (AT) and recombinant thrombomodulin (rhTM) are drugs which can promote anticoagulant activity. These natural anticoagulants work complementary to each other so that may suppress damage-associated molecular patterns (DAMPs) which is a process that may trigger endogenous molecule worsening the SIC. AT and rhTM have similar clinical effect on the other hand this AT-rhTM combination works on different sites and targets in the process. AT-rhTM combination may also suppress leukocyte adhesion and the elevation of circulating levels of the nucleosome, which leads to cell death event. Unfortunately, AT-rhTM combination costs extremely expensive. This article is done by searching journals with keywords “antithrombin”, “thrombomodulin”, and “sepsis-induced coagulopathy” on the search engines. From 55 journals that were reviewed, 46 were found suitable as a reference for this paper. AT-rhTM agent on SIC may reduce the mortality rate following some mechanisms. Further researches are required to identify the efficacy and effectivity of the AT-rhTM combination in treating patients with SIC.