Effective Control of Relapsing Disseminated Intravascular Coagulation in a Patient with Decompensated Liver Cirrhosis by Recombinant Soluble Thrombomodulin

Abstract

A 70-year-old Japanese man was hospitalized for expanding purpura and chronic disseminated intravascular coagulation (DIC) caused by decompensated liver cirrhosis. As there are no effective treatments for chronic DIC caused by liver cirrhosis, we decided to administer recombinant human soluble thrombomodulin (rhsTM) after he provided informed consent. The DIC was rapidly improved; however, the purpura and coagulopathy recurred after two months, and repeated rhsTM treatments were required. The rhsTM treatment sufficiently controlled the coagulopathy for two years, without any complications, including bleeding. This is the first report demonstrating that rhsTM can be administered safely and repeatedly to a patient with decompensated liver cirrhosis, and that it appears to be associated with a favorable outcome.

The two therapeutic strategies of surgical intervention and medical management in a patient with enhanced-fibrinolytic type of disseminated intravascular coagulation after aortic replacement for Stanford type A aortic dissection with chronic heart and renal failure

“…However, it is often difficult due to the patient’s medical condition such as advanced age or severe comorbidities [ 2 , 5 ]. Several anticoagulant agents have been reported to be effective for DIC, such as heparin [ 6 ], synthetic protease inhibitors [ 7 , 8 ], recombinant soluble thrombomodulin [ 9 ], and direct oral anticoagulants [ 4 , 10 ]. Antifibrinolytic agents such as tranexamic acid are generally not recommended for the DIC due to the increased risk of thromboembolic complications, but it could be a reasonable option in combination with anticoagulant agents for DIC with marked activation of fibrinolysis [ 2 , 11 – 13 , 15 ].…”

“…The optimal treatment for DIC associated with aortic disorders is surgical intervention, however it is not often suitable due to the patient's medical condition such as advanced age or severe comorbidities [2,5]. Several case reports showed that medical treatments, such as anticoagulant agents, antifibrinolytic agents, and a combination of both, were effective for inoperable patients with DIC associated with aortic disorders [4,[6][7][8][9][10][11][12][13]. We describe a case in which two strategies of surgical intervention and medical treatment were effective for the enhanced-fibrinolytic type DIC after aortic replacement for Stanford type A aortic dissection with chronic heart and renal failure.…”