Activated protein C is an endogenous modulator with antithrombotic, anti-inflammatory and profibrinolytic properties. Underexpression of activated protein C plays a role in the progression of sepsis. Drotrecogin (Xigris®) is recombinate

One Two Three Four Number of Dysfunctional Organs

Figure 7.1. Mortality is directly associated with the number organ failures.

activated protein C that reduces inflammation, coagulation and increased fibrinolysis. The PROWESS trial evaluated the use of drotrecogin alfa in severe sepsis and found an improved survival at 28 days. Mortality was 24.7% in drotrecogin alfa treatment groups versus 30.8% in control groups. Patients at the highest rick (APACHE > 25) had the greatest benefit with a 13% reduction in mortality. Those patients with APACHE < 20 had the lease benefit. Bleeding complications with the use of drotrecogin alfa are 17% versus 8% in placebo groups.

Current dosing for Xigris is 24 ^g/kg/hour over 4 days. In a recent symposium, patients with significant improvement the infusion was stopped early without any significant loss of benefit. This drug is expensive with a cost of infusion at $6600.00. The end result is 18 patients must be treated to save one life with Xigris.

Back Pain Revealed

Back Pain Revealed

Tired Having Back Pains All The Time, But You Choose To Ignore It? Every year millions of people see their lives and favorite activities limited by back pain. They forego activities they once loved because of it and in some cases may not even be able to perform their job as well as they once could due to back pain.

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