Aortic Aneurysm-associated Disseminated Intravascular Coagulation that Responded Well to a Switch from Warfarin to Rivaroxaban

Abstract

We describe a case in which uncontrolled chronic disseminated intravascular coagulation (DIC) caused by an aortic aneurysm that was exacerbated by chemotherapy for lung cancer, showed dramatic improvement when warfarin, which was being administered for atrial fibrillation, was replaced by rivaroxaban, a direct oral anticoagulant (DOAC). The present case is interesting because a DOAC was effective in treating DIC due to an aortic aneurysm, whereas warfarin, another oral anticoagulant, was ineffective. In controlling DIC, it is important to inhibit activated coagulation factors such as thrombin and activated factor X, rather than the coagulation factors, which act as substrates.

Successful Treatment with Edoxaban for Disseminated Intravascular Coagulation in a Case of Aortic Dissection Complicated with Immune Thrombocytopenic Purpura

“…Therefore, in theory, DOACs may contribute to the treatment of DIC. Some reports have described the efficacy of DOACs other than edoxaban, such as rivaroxaban, apixaban, and dabigatran, in treating chronic DIC ( 11 , 16 - 20 ). In the present case, we chose edoxaban based on a previous meta-analysis of clinical studies of each DOAC for NVAF ( 21 ).…”

Management of Chronic Disseminated Intravascular Coagulation Associated with Aortic Aneurysm/Dissection

“…To date, heparin [8–10], camostat or nafamostat mesilate [17, 18], tranexamic acid [11], combinations of these medications [12], as well as rivaroxaban, a direct oral anticoagulant (DOAC) [13–15], have been reported as beneficial or successful, mostly in case reports and case series. Warfarin, on the contrary, may be less effective because it may worsen coagulopathy by reducing the expression of protein C and protein S (a cofactor of protein C) in patients with chronic DIC associated with aneurysm [14]. Stopping warfarin improved DIC parameters in Patient 1, perhaps for the reason.…”

Successful treatment of disseminated intravascular coagulation associated with aortic dissection

“…Various treatments have been reported to be effective for chronic DIC associated with vascular disease. 1 , 2 , 3 , 4 , 5 , 6 , 7 In particular, direct oral anticoagulants and LMWH are effective and convenient. 1 , 4 , 5 , 6 , 7 Because of the high risk of surgical repair for bleeding tendency, conservative treatment is the first choice for aorta-related DIC.…”

“…Several treatments of DIC from aortic dissection have been reported. 1 , 2 , 3 , 4 , 5 , 6 , 7 Although surgical intervention is sometimes necessary for dilation of the dissecting aortic aneurysm, optimal medical therapy is recommended because of the high risk of surgical repair for bleeding tendency. In addition, endovascular repair for Stanford type B aortic dissection is currently performed frequently and safely.…”