Successful Treatment with Edoxaban for Disseminated Intravascular Coagulation in a Case of Aortic Dissection Complicated with Immune Thrombocytopenic Purpura

Uemura, Shun; Kobayashi, Hironori; Seki, Yoshinobu; Okoshi, Yuki; Sone, Hirohito; Nomoto, Nobuhiko

doi:10.2169/internalmedicine.4255-19

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…Under these circumstances, blood component therapy (e.g., FFP and PC) is recommended to supplement the coagulation factors and platelets that have been consumed [ 9 ]. Several medical strategies have shown effectiveness in controlling DIC due to aortic dissection, including anticoagulation [ 6 , 14 , 15 ], antifibrinolytics [ 8 , 16 , 17 ], and a combination of both [ 11 , 18 , 19 ]. Although anticoagulation is not usually recommended for patients with severe DIC-associated bleeding [ 9 ] because it may cause bleeding complications elsewhere, some reports have shown the effectiveness and safety of anticoagulation treatment for DIC in patients with aortic dissection.…”

Section: Discussionmentioning

confidence: 99%

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

Liu

Lai

2022

BMC Cardiovasc Disord

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Background Disseminated intravascular coagulation (DIC) is a critical and rare complication after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. The optimal treatment of aortic dissection-related DIC remains controversial. Case presentation We herein describe the successful management of a 65-year-old man who presented with gingival bleeding and multiple subcutaneous petechiae and was proven to have DIC after TEVAR of aortic dissection. The patient had initially been discharged with improved laboratory tests after anticoagulation treatment followed by oral rivaroxaban for maintenance. However, he was readmitted with recurrent gingival bleeding 17 days later. The DIC was successfully controlled with a combination of anticoagulation and antifibrinolytics. After the patient was discharged, his treatment was switched to oral tranexamic acid and warfarin for maintenance. During a 15-month follow-up, the patient had no recurrence of hemorrhage symptoms and maintained stable coagulative and fibrinolytic parameters. Conclusions Aortic dissection-related DIC requires long-term management under conservative treatment. The combination of warfarin and tranexamic acid may be a feasible method for long-term maintenance therapy.

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Section: Discussionmentioning

confidence: 99%

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

Liu

Lai

2022

BMC Cardiovasc Disord

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“…Unfractionated heparin, low molecular weight heparin, nafamostat, and thrombomodulin [57,58] are commonly used as anticoagulation therapy in DIC. For long-term outpatient control of DIC, DOACs can also have a dramatic effect on DIC [69,197,[199][200][201][202][203][204][205][206][207][208][209]. Warfarin is also an anticoagulant, but its use in DIC is contraindicated because this agent aggravates DIC [69].…”

Section: Dicmentioning

confidence: 99%

How We Interpret Thrombosis with Thrombocytopenia Syndrome?

Yamada,

Asakura

2024

IJMS

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Platelets play an important role in hemostasis, and a low platelet count usually increases the risk of bleeding. Conditions in which thrombosis occurs despite low platelet counts are referred to as thrombosis with thrombocytopenia syndrome, including heparin-induced thrombocytopenia, vaccine-induced immune thrombotic thrombocytopenia, paroxysmal nocturnal hemoglobinuria, antiphospholipid syndrome, thrombotic microangiopathy (TMA), and disseminated intravascular coagulation. TMA includes thrombotic thrombocytopenic purpura, Shiga toxin-producing Escherichia coli-associated hemolytic uremic syndrome (HUS), and atypical HUS. Patients with these pathologies present with thrombosis and consumptive thrombocytopenia associated with the activation of platelets and the coagulation system. Treatment varies from disease to disease, and many diseases have direct impacts on mortality and organ prognosis if therapeutic interventions are not promptly implemented. Underlying diseases and the results of physical examinations and general laboratory tests as part of a thorough workup for patients should promptly lead to therapeutic intervention before definitive diagnosis. For some diseases, the diagnosis and initial treatment must proceed in parallel. Utilization of not only laboratory tests but also various scoring systems is important for validating therapeutic interventions based on clinical information.

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“…We consider edoxaban as an easy-to-use agent for the treatment of DIC in aortic aneurysms, because dose adjustment based on age and weight is possible and aortic aneurysms are common among elderly Japanese. To date, only one case in which edoxaban was used for DIC has been reported [98].…”

Section: ) Edoxabanmentioning

confidence: 99%

Therapeutic Strategies for Disseminated Intravascular Coagulation Associated with Aortic Aneurysm

Yamada

Asakura

2022

IJMS

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Aortic aneurysms are sometimes associated with enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC). In enhanced-fibrinolytic-type DIC, both coagulation and fibrinolysis are markedly activated. Typical cases show decreased platelet counts and fibrinogen levels, increased concentrations of fibrin/fibrinogen degradation products (FDP) and D-dimer, and increased FDP/D-dimer ratios. Thrombin-antithrombin complex or prothrombin fragment 1 + 2, as markers of coagulation activation, and plasmin-α2 plasmin inhibitor complex, a marker of fibrinolytic activation, are all markedly increased. Prolongation of prothrombin time (PT) is not so obvious, and the activated partial thromboplastin time (APTT) is rather shortened in some cases. As a result, DIC can be neither diagnosed nor excluded based on PT and APTT alone. Many of the factors involved in coagulation and fibrinolysis activation are serine proteases. Treatment of enhanced-fibrinolytic-type DIC requires consideration of how to control the function of these serine proteases. The cornerstone of DIC treatment is treatment of the underlying pathology. However, in some cases surgery is either not possible or exacerbates the DIC associated with aortic aneurysm. In such cases, pharmacotherapy becomes even more important. Unfractionated heparin, other heparins, synthetic protease inhibitors, recombinant thrombomodulin, and direct oral anticoagulants (DOACs) are agents that inhibit serine proteases, and all are effective against DIC. Inhibition of activated coagulation factors by anticoagulants is key to the treatment of DIC. Among them, DOACs can be taken orally and is useful for outpatient treatment. Combination therapy of heparin and nafamostat allows fine-adjustment of anticoagulant and antifibrinolytic effects. While warfarin is an anticoagulant, this agent is ineffective in the treatment of DIC because it inhibits the production of coagulation factors as substrates without inhibiting activated coagulation factors. In addition, monotherapy using tranexamic acid in cases of enhanced-fibrinolytic-type DIC may induce fatal thrombosis. If tranexamic acid is needed for DIC, combination with anticoagulant therapy is of critical importance.

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Successful Treatment with Edoxaban for Disseminated Intravascular Coagulation in a Case of Aortic Dissection Complicated with Immune Thrombocytopenic Purpura

Cited by 5 publications

References 27 publications

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

How We Interpret Thrombosis with Thrombocytopenia Syndrome?

Therapeutic Strategies for Disseminated Intravascular Coagulation Associated with Aortic Aneurysm

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