Preoperative disseminated intravascular coagulation complicated by thoracic aortic aneurysm treated using recombinant human soluble thrombomodulin: A case report.

Abstract

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: Yoshinori Tanigawa, Yasutaka Yamada, Kimihide Nakamura, Tomoko Yamashita, Akira Nakagawachi, Yoshiro Sakaguchi
• Journal: Medicine (Medicine (Baltimore)) Vol. 100 Issue 9 Pg. e25044 (Mar 05 2021) ISSN: 1536-5964 [Electronic] United States
• PMID: 33655983 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.

Chemical References

• Recombinant Proteins
• Thrombomodulin

Topics

• Aged
• Angiography
• Aortic Aneurysm, Thoracic (diagnosis, etiology, surgery)
• Disseminated Intravascular Coagulation (complications, drug therapy)
• Dose-Response Relationship, Drug
• Female
• Humans
• Injections, Intravenous
• Preoperative Care (methods)
• Recombinant Proteins (administration & dosage)
• Thrombomodulin (administration & dosage)
• Vascular Surgical Procedures