PDF(Pubmed)
Abstract：
BACKGROUND: 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.
METHODS: 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.
METHODS: 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%.
METHODS: Therapy was a combination of recombinant human soluble thrombomodulin (rhTM) and an aortic stent-graft treatment.
RESULTS: 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.
CONCLUSIONS: 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.
METHODS: 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.
METHODS: 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%.
METHODS: Therapy was a combination of recombinant human soluble thrombomodulin (rhTM) and an aortic stent-graft treatment.
RESULTS: 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.
CONCLUSIONS: 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.
摘要：
背景：与胸主动脉瘤相关的慢性弥散性血管内凝血（DIC）的特征是纤维蛋白溶解增强，并且被认为在代偿/无症状阶段是稳定的，很少有出血症状.然而,DIC可导致失代偿期/出血性弥散性血管内凝血，导致严重的出血素质，目前尚无治疗主动脉瘤DIC的既定策略。
方法：一名77岁女性接受了血管造影和心导管检查，降主动脉置换手术前。她在术后第2周发展了DIC，无法控制的皮下大出血.
方法：她的急性期DIC评分为7分，根据JapanSCORE，手术后30天内死亡的风险估计为33.6%。
方法：治疗是重组人可溶性血栓调节蛋白（rhTM）和主动脉支架移植治疗的组合。
结果：DIC和出血素质均有短期改善。具有严重DIC的胸主动脉瘤最终通过施用rhTM得到纠正。
结论：我们报告使用rhTM作为一种有效的，具有抗炎活性的新型抗凝药物，用于治疗纤维蛋白溶解抑制的DIC，这通常与脓毒症有关。在出血性素质高的患者中，术前无法通过常规抗凝治疗实现DIC的控制，并且无法进行根治性手术修复，rhTM和血管内治疗的组合可能是一种有效的新治疗选择.
方法：一名77岁女性接受了血管造影和心导管检查，降主动脉置换手术前。她在术后第2周发展了DIC，无法控制的皮下大出血.
方法：她的急性期DIC评分为7分，根据JapanSCORE，手术后30天内死亡的风险估计为33.6%。
方法：治疗是重组人可溶性血栓调节蛋白（rhTM）和主动脉支架移植治疗的组合。
结果：DIC和出血素质均有短期改善。具有严重DIC的胸主动脉瘤最终通过施用rhTM得到纠正。
结论：我们报告使用rhTM作为一种有效的，具有抗炎活性的新型抗凝药物，用于治疗纤维蛋白溶解抑制的DIC，这通常与脓毒症有关。在出血性素质高的患者中，术前无法通过常规抗凝治疗实现DIC的控制，并且无法进行根治性手术修复，rhTM和血管内治疗的组合可能是一种有效的新治疗选择.
