With respect to the effect of recombinant thrombomodulin, a phase 3 randomized controlled trial (RCT) comparing recombinant thrombomodulin and heparin in 234 patients with DIC associated with hematologic malignancy or infection was performed in Japan [16], and a subgroup analysis for infection-based DIC revealed that although the mortality difference was 10.2% (recombinant thrombomodulin: 21.4 vs. heparin: 31.6%), the difference was not statistically significant (95% CI − 9.1 to 29.4%) [17]. Here, THBD is linked to infection.