Are any of you using Xigris in your septic patients? And if so, how effective do you think it is? And have you had to d/c it because of bleeding?
We'll use it on our 'sickest of the sick' septic patients...and i can't say that it's improved the morbidity of these patients, as they're usually circling(sp?) the drain (excuse the expression) before we initiate it. Unfortunately, we've had a run of 'bleeders' (maybe 5 of the last 20!) and it's gotten some of the nurses to question it's effectiveness.??? Have any of you had similar experiences???
I'm aware that it's a fairly 'new' drug in caring for septic-shocky-type patients, and some nurses swear by it (because of the studies shown us by drug-reps...(lilly?))..i'm just wondering if nurses who use it can 'sense' that it's helping?....
You're right, they are not exactly the same thing, but similiar enough to be confusing. C-reactive protein (CRP) test is a non specific lab test that indicates if an inflammatory process is going on. CRP is virtually absent in a healthy person, appears rapidly in response to many injuries. It can also be elevated in pt's with MI, rheumatoid arthritis, rheumatic fever, malignancy, post op and bacterial/viral infections.
Activated protein C is found in the inflammatory response cascade. This guy's job is to break down clots. Since the whole inflammatory response is a viscous cycle, it gets turned on and then continues to restimulate itself, causing clotting then clot lysis in the microcirculation. Because of this, activated protein c levels are low in severe sepsis. This is how Xigris works, it helps stop the cascade by replenishing activated protein c and making the fibrinolytic system work better. ((UUGGH too many big words for a saturday morning)
Hope this helps. It can be a mind-boggling thought process when you delve into the whole coagulation system!
In the ICU I work in the Docs use it early and it has saved all the patients on it. I feel they would not have made it without the drug. But, watching the coag profiles and platlet counts drop so rapidly gets pretty scarey
I understand the concept of septic patients forming extensive micro-thrombi and thus 'using-up' an excessive amount of clotting factors....and that xigris works mostly by preventing this...but you lost me on that 'c-reactive protein' thing. ??? CRP is a marker for acute inflammation...and is thought to perhaps help 'boost' the body's immune response...but does it have anything to do with clotting? And i was under the impression that this micro-clot formation was an abnormal response brought on by sepsis...not some aspect of the normal immune mechanism??
Also, yes the kidney's are easily damaged by hypoperfusion, but the liver isn't as succeptible(sp?) to damage (infarction!?) from this same hypoperfusion???(yes, severe hypotension will hurt any organ, but kidneys are perhaps the most 'fragile') I think the primary reason the liver is unable to 'keep up' with the septic patient's 'burning of clotting factors' has less to do with liver infarction and more to do with the 'speed' that these same factors are being used up. Liver failure isnt always a 'given' in these patients....especially early on.
We use xigris quite often in our ICU...we did a lot of the clinical trials for Lilly (and are still doing them) and I think it made our docs more eager to use it. We have had pretty good results with some very sick patients but I think it is because our docs usually start the drug early in the process when the patient first shows signs of organ dysfunction related to sepsis...instead of waiting until the patient is almost dead! I can only remember bleeding probs in a couple patients (one of whom died as a result of bleeding) but they both had coag problems before the xigris was started but did not meet the critieria for disqualification from its use.
I have a question?? We do alot of xigris here and if you any coag prob. that makes you non eligable and D/C if coag prob. starts. We have very strict guidlines is universal??? or are other places more laks??
In the ICU I work in we have had little success with Xigris but we tend to wait a while before starting it. In order to get it we need two docs (one an intensivist) to order it which can delay the process. We haven't had any major bleeding problems in the patients on it.
We have used it successfully on many septic post gastric bypasses when started in a timely manner. Our surgeons can order it but ID doc and Rx must "approve" the order.
kc ccurn
243 Posts
You're right, they are not exactly the same thing, but similiar enough to be confusing. C-reactive protein (CRP) test is a non specific lab test that indicates if an inflammatory process is going on. CRP is virtually absent in a healthy person, appears rapidly in response to many injuries. It can also be elevated in pt's with MI, rheumatoid arthritis, rheumatic fever, malignancy, post op and bacterial/viral infections.
Activated protein C is found in the inflammatory response cascade. This guy's job is to break down clots. Since the whole inflammatory response is a viscous cycle, it gets turned on and then continues to restimulate itself, causing clotting then clot lysis in the microcirculation. Because of this, activated protein c levels are low in severe sepsis. This is how Xigris works, it helps stop the cascade by replenishing activated protein c and making the fibrinolytic system work better. ((UUGGH too many big words for a saturday morning)
Hope this helps. It can be a mind-boggling thought process when you delve into the whole coagulation system!