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.
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.