Drotrecogin alpha an Activated Protein C, Inactivates clotting factors that limiting the generation of thrombin and inhibits production of inflammatory cytokines.
Mechanism of action: anti thrombotic, anti inflammatory, profibrinolytic.
In 2001, FDA approved the use of drotrecogin alfa (activated protein C ) for the treatment of severe Sepsis.
Drotrecogin alpha produced the largest benefit in the sickest subgroups, with an absolute mortality reduction of 7.4% in patients with more than one organ dysfunction and 13% (P = 0.0002) in patients with APACHE II scores totaling more than 24.
The treatment was effective regardless of age, severity of illness, the number of dysfunctional organs or systems, the site of infection (pulmonary or extrapulmonary), and the type of infecting organism (gram-positive, gram-negative, or mixed.
Caution is advised in:-
INR>3.0
Platelets count
hmmm... the Eli Lily company has removed xigris off the shelves due to safety concern and the so called benefit was likened to compare apple to an orange, as the "benefit" data was concluded by comparing a prospective data on treatment with APC to retrospective data aged years ago without it. Thus one of the BIG conclusion was the mortality benefit was largely drive by the improvement in ICU care in recent years rather than APC itself
I had attended the launch of Drotrecogin alpha in the South Indian Market- way back in 2007-08, and there was a talk given by an intensivist who was using the product for cases of sepsis at that time, but somehow, the literature and clarity on the product was not satisfactory, and many who attended the program were skeptical about implementing its usage in their practice.
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