RATIONALE: Chronic disseminated intravascular coagulation (DIC) associated with thoracic aortic aneurysm is characterized by enhanced fibrinolysis and is thought to be stable in the compensated/asymptomatic stage, with few bleeding symptoms. However, DIC can lead to decompensated/hemorrhagic stage disseminated intravascular coagulation, resulting in severe bleeding diathesis, and there is currently no established strategy for treatment of DIC in aortic aneurysms. PATIENT CONCERNS: A 77-year-old woman underwent angiography and cardiac catheterization, before descending aortic replacement surgery. She developed DIC in postprocedure week 2 with extensive, uncontrollable massive subcutaneous hemorrhage. DIAGNOSES: Her acute-phase DIC score was 7 points, and the risk of mortality within 30 days after surgery according to the JapanSCORE was estimated to be 33.6%. INTERVENTIONS: Therapy was a combination of recombinant human soluble thrombomodulin (rhTM) and an aortic stent-graft treatment. OUTCOMES: Short-term improvements were seen in both DIC and bleeding diathesis. The thoracic aortic aneurysm with severe DIC was eventually corrected by administration of rhTM. LESSONS: We report the use of rhTM as an effective, novel anticoagulant drug with anti-inflammatory activity for treating DIC with suppressed fibrinolysis, which is typically associated with sepsis. In patients with a high hemorrhagic diathesis, in whom preoperative control of DIC cannot be achieved with conventional anticoagulation and radical surgical repair cannot be performed, a combination of rhTM and endovascular therapy may be a powerful new treatment option.
RATIONALE: Chronic disseminated intravascular coagulation (DIC) associated with thoracic aortic aneurysm is characterized by enhanced fibrinolysis and is thought to be stable in the compensated/asymptomatic stage, with few bleeding symptoms. However, DIC can lead to decompensated/hemorrhagic stage disseminated intravascular coagulation, resulting in severe bleeding diathesis, and there is currently no established strategy for treatment of DIC in aortic aneurysms. PATIENT CONCERNS: A 77-year-old woman underwent angiography and cardiac catheterization, before descending aortic replacement surgery. She developed DIC in postprocedure week 2 with extensive, uncontrollable massive subcutaneous hemorrhage. DIAGNOSES: Her acute-phase DIC score was 7 points, and the risk of mortality within 30 days after surgery according to the JapanSCORE was estimated to be 33.6%. INTERVENTIONS: Therapy was a combination of recombinant human soluble thrombomodulin (rhTM) and an aortic stent-graft treatment. OUTCOMES: Short-term improvements were seen in both DIC and bleeding diathesis. The thoracic aortic aneurysm with severe DIC was eventually corrected by administration of rhTM. LESSONS: We report the use of rhTM as an effective, novel anticoagulant drug with anti-inflammatory activity for treating DIC with suppressed fibrinolysis, which is typically associated with sepsis. In patients with a high hemorrhagic diathesis, in whom preoperative control of DIC cannot be achieved with conventional anticoagulation and radical surgical repair cannot be performed, a combination of rhTM and endovascular therapy may be a powerful new treatment option.
Authors: Mario Monaco; Luigi Di Tommaso; Paolo Stassano; Raffaele Smimmo; Vincenzo De Amicis; Antonio Pantaleo; Giovanni Battista Pinna; Gabriele Iannelli Journal: Interact Cardiovasc Thorac Surg Date: 2006-08-02
Authors: H Saito; I Maruyama; S Shimazaki; Y Yamamoto; N Aikawa; R Ohno; A Hirayama; T Matsuda; H Asakura; M Nakashima; N Aoki Journal: J Thromb Haemost Date: 2006-10-13 Impact factor: 5.824
Authors: Jean-Louis Vincent; Mayakonda K Ramesh; David Ernest; Steven P LaRosa; Jan Pachl; Naoki Aikawa; Eric Hoste; Howard Levy; Joe Hirman; Marcel Levi; Mradul Daga; Demetrios J Kutsogiannis; Mark Crowther; Gordon R Bernard; Jacques Devriendt; Joan Vidal Puigserver; Daniel U Blanzaco; Charles T Esmon; Joseph E Parrillo; Louis Guzzi; Seton J Henderson; Chaicharn Pothirat; Parthiv Mehta; Jawed Fareed; Deepak Talwar; Kazuhisa Tsuruta; Kenneth J Gorelick; Yutaka Osawa; Inder Kaul Journal: Crit Care Med Date: 2013-09 Impact factor: 7.598