Severe sepsis treated with activated protein C

BACKGROUND: Severe sepsis is a common cause of mortality in critically ill patients. Drotrecogin alfa (activated), synonymous with recombinant human activated protein C (rhAPC), is a new therapeutic tool with anticoagulant, anti-inflammatory and profibrinolytic properties with proven effect in reducing mortality in severe sepsis. MATERIAL AND METHODS: As part of a multi-centre study, the patients received an infusion of rhAPC, 24 microg/kg/h for 96 hours according to an open-labeled phase IIIb study protocol. RESULTS: Out of a total of 28 patients, 6 (21%) died before day 28. One of the deaths was classified as possibly related to rhAPC. In three patients rhAPC was transiently stopped because of surgery or postoperative bleeding. Use of the compound rarely interfered with commonly used diagnostic and therapeutic procedures. INTERPRETATION: Treatment with rhAPC is easily carried out in an intensive care unit. Patients with severe sepsis and two or more failing vital organs should be considered for treatment with rhAPC.