A Case of Disseminated Intravascular Coagulation Complicating Thoracic Aortic Aneurysm for Which Recombinant Human Soluble Thrombomodulin Was Effective

賢, 中村; 宏次, 川人; 宏邦, 長沼; 圭, 田中; 洋高, 松村; 典靖, 川田; 功成, 配島; 和弘, 橋本

doi:10.4326/jjcvs.41.148

Cited by 2 publications

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“…Previous studies have demonstrated that the effective adjunctive treatments for chronic DIC due to aortic aneurysm were: continuous heparin infusion (11), subcutaneous injection of low molecular weight heparin (6,(12)(13)(14), the intravenous injection of danaparoid with the oral administration of tranexamic acid (15), and thrombomodulin (16,17) with or without platelet and FFP transfusion for the acute phase of exacerbation of chronic DIC. However, the intravenous or subcutaneous administration of these medicines for the prevention of an exacerbation of chronic DIC in outpatients for an extended period of time is difficult.…”

Section: Discussionmentioning

confidence: 99%

Use of Rivaroxaban for the Effective Management of Disseminated Intravascular Coagulation Associated with Abdominal Aortic Aneurysm

et al. 2015

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A 67-year-old man with non-valvular atrial fibrillation (AF) and previous myocardial and cerebral infarctions had uncontrollable bleeding after undergoing dental extraction because of an exacerbation of chronic disseminated intravascular coagulation (DIC) due to an abdominal aortic aneurysm. After successful treatment of the bleeding with the transfusion of fresh frozen plasma and platelets, nafamostat mesilate was used to treat the chronic DIC. Finally, rivaroxaban (an oral direct Factor Xa inhibitor) was prescribed for chronic DIC, as well as non-valvular AF. Following the initiation of rivaroxaban, the chronic DIC gradually improved, and the patient was discharged.

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Section: Discussionmentioning

confidence: 99%

Use of Rivaroxaban for the Effective Management of Disseminated Intravascular Coagulation Associated with Abdominal Aortic Aneurysm

et al. 2015

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“…Previous studies reported that treatment of endoleaks after endovascular aortic repair resulted in resolution of DIC. [3][4][5] Although anticoagulation therapy such as recombinant human soluble thrombomodulin may be effective for the treatment of chronic DIC caused by consumption of coagulation factors with stagnation of blood flow in the patent false lumen or large aneurysm, 6,7) there is no evidence that anticoagulation therapy is effective for the treatment of postoperative DIC after endovascular repair. Antifibrinolytic therapy may be applicable to treat DIC after endovascular repair.…”

Section: Disclosure Statementmentioning

confidence: 99%

A Case of Disseminated Intravascular Coagulation after Thoracic Endovascular Aortic Repair

Kotani

2015

Annals of Vascular Diseases

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I report a hemorrhagic complication due to disseminated intravascular coagulation after thoracic endovascular aortic repair for a dissecting aortic aneurysm. A 74-year-old man underwent thoracic endovascular aortic repair and carotidcarotid artery bypass to close the primary entry site of the dissecting aortic aneurysm. Postoperatively, he developed a gradually expanding cervical hematoma. Laboratory data showed disseminated intravascular coagulation. He could not extubated until postoperative day 6 because of the risk of airway obstruction. He was treated with transfusion to replenish the coagulation factor. Disseminated intravascular coagulation may occur secondary to thrombus formation in the false lumen after thoracic endovascular aortic repair.Keywords: disseminated intravascular coagulation, aortic aneurysm, blood vessel prosthesis but had not been followed up. Computed tomographic angioglaphy showed a Stanford type B chronic aortic dissection extending from the distal aortic arch to the abdominal aorta, with the false lumen entirely patent (Fig. 1a). The primary entry site was 20 mm distal to the origin of the left subclavian artery (Fig. 1b), and the re-entry site was at the origin of the left renal artery. The maximum diameter of the distal aortic arch was 72 mm, and the diameter of the descending aorta was 65 mm. The celiac axis, superior mesenteric artery and right renal artery originated from the true lumen. Laboratory data showed mild coagulopathy: fibrinogen 262 mg/dl, prothrombin time international normalized ratio 1.39, activated partial thromboplastin time 34.5. Liver function test was within normal limits. It would have been difficult to perform conventional replacement of the descending aorta via left thoracotomy because the patient had been bedridden for a long time and could not even stretch the left arm and could not be placed in the left lateral position due to joint contracture. To avoid the risk associated with conventional open surgery, I decided to perform TEVAR to close the primary entry site.The procedure was performed under general anesthesia using the Zenith TX2 TAA Endovascular Graft (Cook Medical, Bloomington, Ind). To ensure enough length of the healthy aorta at the proximal neck, the stent graft was positioned so that it covered the origins of the left common carotid artery and left subclavian arteries after carotidcarotid artery bypass (Fig. 2a). The left subclavian artery was not revascularized because preoperative magnetic resonance imaging showed communication between the right and left vertical arteries. The origin of the left subclavian artery was embolized with metallic coils to prevent a type 2 endoleak. The primary entry site in the distal aortic arch was covered with the stent graft, and postoperative angiography did not show contrast medium in the false lumen of the thoracic aorta (Fig. 2b). The re-entry site at the origin of the left renal artery was not closed. The operation time was 276 min and no blood transfusion was needed.After surgery, the patient was transfe...

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A Case of Disseminated Intravascular Coagulation Complicating Thoracic Aortic Aneurysm for Which Recombinant Human Soluble Thrombomodulin Was Effective

Cited by 2 publications

References 3 publications

Use of Rivaroxaban for the Effective Management of Disseminated Intravascular Coagulation Associated with Abdominal Aortic Aneurysm

Use of Rivaroxaban for the Effective Management of Disseminated Intravascular Coagulation Associated with Abdominal Aortic Aneurysm

A Case of Disseminated Intravascular Coagulation after Thoracic Endovascular Aortic Repair

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