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July 9, 2003

Unraveling Severe Sepsis: Why Did OPTIMIST Fail and What's Next?

Author Affiliations

Author Affiliation: Department of Critical Care Medicine, Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Laboratory, University of Pittsburgh, Pittsburgh, Pa (Dr Angus), and Department of Medicine, McMaster University, Hamilton, Ontario (Dr Crowther).

JAMA. 2003;290(2):256-258. doi:10.1001/jama.290.2.256

In this issue of THE JOURNAL, Abraham and colleagues1 report the results of an international, multicenter randomized controlled trial (optimized phase 3 tifacogin in multicenter international sepsis trial [OPTIMIST]) that compared a 96-hour infusion of recombinant tissue factor pathway inhibitor (TFPI) with placebo in 1754 critically ill patients with sepsis and mild coagulopathy (international normalized ratio [INR] ≥1.2). Tissue factor pathway inhibitor, a naturally occurring anticoagulant, modulated the coagulation cascade but did not impact the mortality rate.