Management of Chronic Disseminated Intravascular Coagulation Associated with Aortic Aneurysm/Dissection

Table 1

Clinical features of 4 cases of chronic DIC in association with aortic aneurysm/dissection.

	Case 1	Case 2	Case 3	Case 4
Age/sex	84/F	87/M	91/F	83/F
Causes of DIC	AA	AD	CIAA/IIAA	AA
Surgical procedures (EVAR)	Yes (pre-)	Yes (pre-)	Yes (post-)	None
Site(s)/event(s) of bleeding	Subcutaneous	Tooth extraction	Gingiva	GI tract
Data on DIC
Platelet counts (/µL)	64,000	73,000	100,000	62,000
Fibrinogen (mg/dL)	98	73	72	79
FDP/D-dimer (µg/mL)	101/49.8	96.8/24	109/51.4	177/81.7
TAT/PIC (ng, µg/mL)	40.5/12.7	58/17.6	49/NA	69.2/12.6
DIC score	11	7	6	7
Treatment
Supportive	None	PRBC	PRBC, FFP	PRBC, FFP, PC
Treatment for coagulopathy
Initial	Heparin (DIV) + TA (DIV)	Heparin (SC) + TA (PO)	TA (DIV)	Heparin (DIV) + TA(DIV)
Later	Heparin (SC) + TA (PO)	Heparin (SC) + TA (PO)	Surgical (EVAR)
Maintenance	Rivaroxaban (PO)	Rivaroxaban (PO)
Outcome
DIC	Well controlled	Well controlled	Well controlled	Delayed control
Alive/dead	Alive	Alive	Alive	Dead

DIC = disseminated intravascular coagulation, AA = aortic aneurysm, AD = aortic dissection, FDP = fibrin degradation product, TAT = thrombin-antithrombin complex, PIC = plasmin-α2 plasmin inhibitor complex, GI = gastrointestinal, PRBC = packed red blood cell, FFP = fresh frozen plasma, PC = platelet concentrates, TA = tranexamic acid, EVAR = endovascular aortic repair, pre- = prior to DIC development, post- = after DIC development, DIV = drip infusion, SC = subcutaneous injection, PO = per oral, CIAA = common iliac artery aneurysm, and IIAA = internal iliac artery aneurysm. Based on the DIC criteria of the Ministry of Health and Welfare of Japan; died of aspiration pneumonia.