Age is Associated with the Efficacy of Anticoagulant Therapies Against Sepsis-Induced Disseminated Intravascular Coagulation

Background: Disseminated intravascular coagulation (DIC) commonly complicates sepsis and considerably worsens mortality. Recent studies suggested that anticoagulant therapies improved mortality only in specific sepsis populations, and key pathologies for selecting optimal targets needed to be identified. Anticoagulant activities were naturally altered with aging. This study aimed to evaluate age-related differences in efficacy of anticoagulant therapies in sepsis. Methods: : This post hoc analysis of a nationwide multicenter cohort study was conducted in 42 intensive care units in Japan. Adult patients with septic DIC were divided into anticoagulant and control groups. Age-related changes in predicted mortality in both groups were compared using a logistic regression model including two-way interaction terms. Patients were also stratified into three subsets based on age, and propensity score-adjusted Cox regression analyses were conducted to examine survival effect of anticoagulants in each subset. Results: : We included 1432 patients with septic DIC; 867 patients received anticoagulants and 565 received none. Age-related change in predicted mortality was significantly different between groups (p for interaction = 0.013), and the gap between groups was broad in the younger population. Similarly, in Cox regression analyses, anticoagulant therapies were associated with significantly lower mortality in the subsets of age ≤60 and 60-79 (hazard ratios = 0.461, 0.617, p = 0.007, 0.005, respectively), whereas there was no difference in survival between the groups in the subsets of age ≥80. Conclusion: The efficacy of anticoagulant therapies for septic DIC might be associated with patient age.