Abstract
Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.
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Kasper DL, Harrison TR. Harrison’s Principles of Internal Medicine. 16th ed. New York: McGraw-Hill Medical Pub Division, 2005
Bick RL. Disseminated intravascular coagulation: current concepts of etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin North Am 2003; 17(1): 149–176
Wada H, Gabazza EC, Asakura H, Koike K, Okamoto K, Maruyama I, Shiku H, Nobori T. Comparison of diagnostic criteria for disseminated intravascular coagulation (DIC): diagnostic criteria of the International Society of Thrombosis and Hemostasis and of the Japanese Ministry of Health and Welfare for overt DIC. Am J Hematol 2003; 74(1): 17–22
Micallef-Eynaud PD, Ludlam CA. Aortic aneurysms and consumptive coagulopathy. Blood Coagul Fibrinolysis 1991; 2(3): 477–481
Jelenska MM. Coagulation parameters as predictors of DIC in patients with intact aortic aneurysm. Hamostaseologie 2004; 24(3): 162–166
Fine NL, Applebaum J, Elguezabal A, Castleman L. Multiple coagulation defects in association with dissecting aneurysm. Arch Intern Med 1967; 119(5): 522–526
Fernandez-Bustamante A, Jimeno A. Disseminated intravascular coagulopathy in aortic aneurysms. Eur J Intern Med 2005; 16(8): 551–560 PMID:16314235
Siebert WT, Natelson EA. Chronic consumption coagulopathy accompanying abdominal aortic aneurysm. Arch Surg 1976; 111(5): 539–541
Taylor FB, Toh CH, Hoots WK, Wada H, Levi M; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society on Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86(5): 1327–1330
Fisher DF, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. A prospective study of 76 cases. Arch Surg 1983; 118(11): 1252–1255
Jimeno A, Toledo T, Moya I, González-Barber A. Chronic disseminated intravascular coagulation caused by an aorto-bife-moral aneurysm. Eur J Intern Med 2005; 16(4): 298–300
Liu W, Zhang L, Liu Y, Liu X, Xue F, Chen Y, Huang Y, Yang R. Chronic disseminated intravascular coagulopathy associated with aortic dissecting aneurysms: two cases report and literature review. Chin J Hematol (Zhonghua Xue Ye Xue Za Zhi) 2014; 35(9): 831–834 (in Chinese)
Levi M, de Jonge E, van der Poll T. New treatment strategies for disseminated intravascular coagulation based on current understanding of the pathophysiology. Ann Med 2004; 36(1): 41–49
Hoots WK. Non-overt disseminated intravascular coagulation: definition and pathophysiological implications. Blood Rev 2002; 16(Suppl 1): S3–S9
Straub PW, Kessler S. Metabolism and localization of 131Ifibrinogen in chronic intravascular coagulation. Schweiz Med Wochenschr 1970; 100(46): 2001–2003 (in German)
Carroccio A, Ellozy SH, Marin ML, Hollier LH. Ten years’ experience treating abdominal aortic aneurysms with stent-grafts. Adv Surg 2004; 38: 267–280
Sakamoto I, Matsuyama N, Fukushima A, Hayashi H, Nishida A, Hazama S, Noguchi M, Eishi K, Hayashi K. Chronic aortic dissection complicated by disseminated intravascular coagulation: successful treatment with endovascular stent-grafting. J Endovasc Ther 2003; 10(5): 953–957
Aboulafia DM, Aboulafia ED. Aortic aneurysm-induced disseminated intravascular coagulation. Ann Vasc Surg 1996; 10(4): 396–405
Perry JH, Lazar HL, Quillen K, Sloan JM. Successful long-term management of aneurysm-associated chronic disseminated intravascular coagulation with low molecular weight heparin. J Card Surg 2012; 27(6): 730–735
Kamineni R, Heuser RR. Abdominal aortic aneurysm: a review of endoluminal treatment. J Interv Cardiol 2004; 17(6): 437–445
Mueller MM, Bomke B, Seifried E. Fresh frozen plasma in patients with disseminated intravascular coagulation or in patients with liver diseases. Thromb Res 2002; 107(Suppl 1): S9–S17
Tsuji T, Morikawa K, Hirano T, Yamasaki H, Tsuda H. Effective treatment with tranexamic acid for chronic disseminated intravascular coagulation associated with aortic dissection. Rinsho Ketsueki 2013; 54(8): 769–771 (in Japanese)
Hoshina K, Kaneko M, Hosaka A, Okamoto H, Shigematsu K, Miyata T. Lessons learned from a case of abdominal aortic aneurysm accompanied by unstable coagulopathy. Case Rep Vasc Med 2012; 2012:265860
Iyama S, Sato T, Murase K, Kamihara Y, Ono K, Kikuchi S, Takada K, Miyanishi K, Sato Y, Takimoto R, Kobune M, Kato J. Intermittent administration of recombinant human soluble thrombomodulin successfully controlled chronic disseminated intravascular coagulation in a patient with dissecting aortic aneurysm on an outpatient basis. Blood Coagul Fibrinolysis 2012; 23(6): 548–550
Hayakawa K, Tamura S, Gima H, Hayakawa T, Kurihara T, Ooura M, Nakano Y, Souri M, Ichinose A, Fujimoto T. Successful treatment of chronic disseminated intravascular coagulation using recombinant human soluble thrombomodulin in a dialysis patient with dissecting aortic aneurysm. Rinsho Ketsueki 2014; 55(11): 2300–2305
Hayashi T, Nakagawa N, Kadohira Y, Morishita E, Asakura H. Rivaroxaban in a patient with disseminated intravascular coagulation associated with an aortic aneurysm: a case report. Ann Intern Med 2014; 161(2): 158–159
Hoshina K, Shigematsu K, Hosaka A, Okamoto H, Miyata T, Watanabe T. The effect of recombinant human soluble thrombomodulin on disseminated intravascular coagulation in an abdominal aortic aneurysm. Blood Coagul Fibrinolysis 2014; 25(4): 389–391
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We thank all of our colleagues at the Peking Union Medical College Hospital who were involved in patient care and medical records management and research.
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Zhang, Y., Li, C., Shen, M. et al. Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients. Front. Med. 11, 62–67 (2017). https://doi.org/10.1007/s11684-017-0498-7
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DOI: https://doi.org/10.1007/s11684-017-0498-7