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Guido Alsfasser, MD; Andrew L. Warshaw, MD; Sarah P. Thayer, MD, PhD; Bozena Antoniu, MS; Michael Laposata, MD, PhD; Kent B. Lewandrowski, MD; Carlos Fernández-del Castillo, MD

Arch Surg. 2006;141:670-676.

Hypothesis  Drotrecogin alfa (activated), the pharmacologic form of activated protein C and the first Food and Drug Administration–approved drug for treatment of severe sepsis, is beneficial in experimental acute pancreatitis (AP).

Design  Animal study.

Setting  Laboratory.

Subjects  Male Sprague-Dawley rats.

Interventions  Mild (intravenous cerulein) or severe (intravenous cerulein plus intraductal glycodeoxycholic acid) AP was induced in 72 rats, and coagulation evaluated. Rats with severe AP were randomized to treatment with drotrecogin alfa (activated), 100 µg/kg per hour, or isotonic sodium chloride.

Main Outcome Measures  Histologic scoring of pancreatic necrosis, inflammation of the pancreas and lung (measured by myeloperoxidase concentration), coagulation measures, and 24-hour survival.

Results  Severe consumptive coagulopathy, hemoconcentration, and leukocytosis were observed 6 hours after induction of severe AP, but not in mild AP. Treatment of AP with drotrecogin did not worsen coagulation measures. Although the degree of pancreatic necrosis was comparable in treated and untreated animals with severe AP, drotrecogin significantly reduced myeloperoxidase levels in the pancreas (P = .009) and lungs (P = .03). The 24-hour survival in severe AP was markedly improved in animals treated with drotrecogin (86% vs 38%; P = .05).

Conclusions  Animals with severe AP have severe consumptive coagulopathy, but administration of drotrecogin alfa (activated), 100 µg/kg per hour, does not worsen coagulation abnormalities. Drotrecogin treatment reduces inflammation in the pancreas and lungs and significantly improves survival. These results encourage clinical investigation of drotrecogin in the treatment of severe AP.

Author Affiliations: Departments of Surgery (Drs Alsfasser, Warshaw, Thayer, and Fernández-del Castillo and Ms Antoniu) and Pathology (Drs Laposata and Lewandrowski), Massachusetts General Hospital, Harvard Medical School, Boston.

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