Preoperative disseminated intravascular coagulation (DIC) associated with aortic aneurysm ? does it need to be corrected before surgery?

Abstract

Disseminated intravascular coagulation (DIC) is one of the complications accompanying aortic aneurysm. We herein report four patients with aortic aneurysm who had DIC preoperatively. In all four cases, DIC was corrected immediately after surgery; however, in two cases, DIC could not be corrected preoperatively. This prompted us to reconsider the importance of correcting DIC before surgery. Of the four cases reported in this paper, DIC existed even at the time of surgery in two cases, in spite of meticulous treatment with heparin and/or protease inhibitor; however, the DIC could be removed postoperatively even in these two cases. Surgeons should not waste time with intensive DIC treatment preoperatively. If the DIC cannot be corrected within more than 2 weeks of meticulous treatment, surgeons should then perform surgery on the patient. In addition, it is also essential to ensure that the DIC is due to the aneurysm itself and that no other disease processes have been overlooked.

Effect of Combined Therapy of Danaparoid Sodium and Tranexamic Acid on Chronic Disseminated Intravascular Coagulation Associated With Abdominal Aortic Aneurysm

“…In patients with DIC, local activation of coagulation results in the systemic depletion of coagulation factors and platelets, 1 and the basic principal for treating DIC is anticoagulation therapy, such as heparin. 7,8,11,12 Cummins et al reported that long-term treatment with LMWH could provide good symptomatic control of chronic DIC associated with AAA, 5 and as far as we could ascertain, there is not a great difference between LMWH and UFH. However, subcutaneous injection was ruled out because of the large purpura at the site of injection and so we needed to use a drug that could be administered as a bolus injection.…”

<i>Helicobacter pylori</i> Eradication Therapy for Thrombocytopenia after Surgery for Abdominal Aortic Aneurysm with Disseminated Intravascular Coagulation

“…Preoperative DIC is a severe complication; however, the therapeutic strategy in AAA with DIC remains controversial. 3,4) Since Fine et al 1) reported a case of consumptive coagulopathy of a dissected aneurysm in 1967, there have been many reports on AAA-associated coagulopathy. [2][3][4] Some reports indicate surgery for AAA enables correction of thrombocytopenia.…”

“…3,4) Since Fine et al 1) reported a case of consumptive coagulopathy of a dissected aneurysm in 1967, there have been many reports on AAA-associated coagulopathy. [2][3][4] Some reports indicate surgery for AAA enables correction of thrombocytopenia. Oba et al 3) opinioned that surgeons should not expend an undue amount of time to correct DIC preoperatively.…”

“…[2][3][4] Some reports indicate surgery for AAA enables correction of thrombocytopenia. Oba et al 3) opinioned that surgeons should not expend an undue amount of time to correct DIC preoperatively. In contrast, Gasabarini et al 5) insisted that the detection of H. pylori infection should be considered in the clinical work-up of adults with typical ITP.…”

“…1,2) However, the strategy for preoperative intravenous conservative treatment is controversial. 3,4) We report a case of a large AAA (maximum diameter: 90 mm) with thrombocytopenia who underwent emergency laparotomy for abdominal aorta replacement thrombocytopenic cases such as DIC, pernicious anemia, thrombotic thrombocytopenic purpura, systemic lupus erythematosus, aortic aneurysms, and drug-induced thrombocytopenia. The patient recovered and was discharged after 1 month with an advice to undergo routine follow-up at the outpatient clinic.…”