Management of disseminated intravascular coagulation associated with aortic aneurysm and vascular malformations

Yamada, Shinya; Asakura, Hitoshi

doi:10.1007/s12185-020-03028-z

Cited by 17 publications

(28 citation statements)

References 56 publications

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“…Our data demonstrated that the coagulation profile in patients with DIC was suppressed-fibrinolytic-type DIC (Fig. 1 and Additional file 1 ), which was typical in sepsis-induced DIC as reflected by markedly increased TAT, mildly increased PIC, mildly increased FDP, and markedly increased total PAI-1 [ 25 , 26 ]. Patients with hypomagnesemia had more activated coagulation status than those with normal magnesium level or hypermagnesemia and it was significantly associated with DIC after adjusting for several confounders, including APACHE II score (effect of severity), serum lactate levels (effect of microcirculation) [ 27 ], and bilirubin levels (effect of hepatic inflammatory and coagulation processes) [ 28 ].…”

Section: Discussionmentioning

confidence: 84%

Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study

et al. 2022

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Background Hypomagnesemia reportedly has significant associations with poor clinical outcomes such as increased mortality and septic shock in patients with sepsis. Although the mechanism underlying these outcomes mostly remains unclear, some experimental data suggest that magnesium deficiency could potentiate coagulation activation in sepsis. However, in sepsis, the association between serum magnesium levels and coagulopathy, including disseminated intravascular coagulation (DIC), remains unknown. Thus, we aimed to investigate the relationship between serum magnesium levels and coagulation status and the association between hypomagnesemia and DIC in patients with sepsis. Methods This retrospective observational study was conducted at the intensive care unit (ICU) of a university hospital from June 2011 to December 2017. Patients older than 19 years who met the Sepsis-3 definition were included. We categorized patients into three groups according to their serum magnesium levels: hypomagnesemia (< 1.6 mg/dL), normal serum magnesium level (1.6–2.4 mg/dL), and hypermagnesemia (> 2.4 mg/dL). We investigated the association between serum magnesium levels and overt DIC at the time of ICU admission according to the criteria of the International Society on Thrombosis and Haemostasis. Results Among 753 patients included in this study, 181 had DIC, 105 had hypomagnesemia, 552 had normal serum magnesium levels, and 96 had hypermagnesemia. Patients with hypomagnesemia had a more activated coagulation status indicated by lower platelet counts, lower fibrinogen levels, higher prothrombin time-international normalized ratios, higher thrombin-antithrombin complex, and more frequent DIC than those with normal serum magnesium levels and hypermagnesemia (DIC: 41.9% vs. 20.6% vs. 24.0%, P < 0.001). The coagulation status in patients with hypomagnesemia was more augmented toward suppressed fibrinolysis than that in patients with normal serum magnesium levels and hypermagnesemia. Multivariate logistic regression revealed that hypomagnesemia was independently associated with DIC (odds ratio, 1.69; 95% confidence interval, 1.00–2.84; P = 0.048) after adjusting for several confounding variables. Conclusions Patients with hypomagnesemia had a significantly activated coagulation status and suppressed fibrinolysis. Hypomagnesemia was independently associated with DIC in patients with sepsis. Therefore, the treatment of hypomagnesemia may be a potential therapeutic strategy for the treatment of coagulopathy in sepsis.

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Section: Discussionmentioning

confidence: 84%

Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study

et al. 2022

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“…It is believed that chronic consumption in the aneurysm is within compensation. 7 We suspected he chronically lacked FXIII, but his FXIII requirement increased because of the cerebral contusion and head trauma, and FXIII became depleted. He had a history of acute myeloid leukemia, and although it was postremission, it was possible that the synthesis of FXIII was below that of healthy individuals.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Bleeding after Head Trauma Caused by Acquired Factor XIII Deficiency

Nao

Nishioka

Yuzuriha

2022

Plastic and Reconstructive Surgery - Global Open

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Summary: Factor XIII (FXIII) is the final factor in the coagulation cascade. FXIII plays a critical role in clot stabilization by cross-linking fibrin and making the clot denser and stiffer. FXIII plays crucial roles in platelet clot retraction, wound healing, and tissue repair. When FXIII is deficient, unusual bleeding that persists for several days, delayed healing, and morbid granulation may occur. We present a case of acquired FXIII deficiency presenting as recurrent bleeding after head trauma. A 66-year-old man fell from a ladder and sustained a head injury. The patient had a history of postremission acute myeloid leukemia and Stanford type B aortic dissection and was on three antihypertensives but no antiplatelets or anticoagulants. Approximately 1 month postinjury, the patient suddenly experienced repeated bleeding and hematoma. Routine coagulation tests were normal; therefore, we suspected another type of coagulation disorder. Low FXIII activity was identified 39 days postinjury. We immediately administered concentrated human coagulation FXIII (Fibrogammin P). The patient’s head contusion was completely healed by day 55 postinjury. Acquired FXIII deficiency should be considered when routine coagulation test results are normal. Plastic surgeons who treat injuries routinely must be cognizant of FXIII deficiency because the condition can be life-threatening and early detection is important. Whenever the process of wound healing is unusual or hematoma and bleeding recur unexpectedly with no clear explanation—despite suitable treatments—FXIII deficiency should be suspected and, if present, must be appropriately treated without delay.

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“…However, in many medical facilities, tests such as TAT and PIC must be outsourced, and checking the results on the same day and adjusting the treatment plan accordingly is therefore difficult. In such cases, a decrease in fibrinogen, a marked increase in FDP, a moderate increase in D-dimer, and an increase in the FDP/D-dimer ratio should be considered as indicators of significant fibrinolytic activation, and the test results should be utilized to inform adjustments to treatment plans on the same day [ 93 , 95 , 101 , 104 ]. In addition, medical facilities that treat a large number of patients with severe COVID-19 should work to obtain the capability to measure TAT and PIC at their own facilities.…”

Section: Covid-19-associated Coagulopathymentioning

confidence: 99%

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

Yamada

Asakura

2022

IJMS

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Coronavirus Disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is frequently complicated by thrombosis. In some cases of severe COVID-19, fibrinolysis may be markedly enhanced within a few days, resulting in fatal bleeding. In the treatment of COVID-19, attention should be paid to both coagulation activation and fibrinolytic activation. Various thromboses are known to occur after vaccination with SARS-CoV-2 vaccines. Vaccine-induced immune thrombotic thrombocytopenia (VITT) can occur after adenovirus-vectored vaccination, and is characterized by the detection of anti-platelet factor 4 antibodies by enzyme-linked immunosorbent assay and thrombosis in unusual locations such as cerebral venous sinuses and visceral veins. Treatment comprises high-dose immunoglobulin, argatroban, and fondaparinux. Some VITT cases show marked decreases in fibrinogen and platelets and marked increases in D-dimer, suggesting the presence of enhanced-fibrinolytic-type disseminated intravascular coagulation with a high risk of bleeding. In the treatment of VITT, evaluation of both coagulation activation and fibrinolytic activation is important, adjusting treatments accordingly to improve outcomes.

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Management of disseminated intravascular coagulation associated with aortic aneurysm and vascular malformations

Cited by 17 publications

References 56 publications

Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study

Association between hypomagnesemia and coagulopathy in sepsis: a retrospective observational study

Recurrent Bleeding after Head Trauma Caused by Acquired Factor XIII Deficiency

Coagulopathy and Fibrinolytic Pathophysiology in COVID-19 and SARS-CoV-2 Vaccination

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