The usefulness of tranexamic acid for bleeding symptoms of chronic consumptive coagulopathy complicated by aortic disease: a single-institute, retrospective study of 14 patients

Abstract

Background Tranexamic acid (TXA) is an antifibrinolytic drug that blocks lysine-binding sites on the profibrinolytic enzyme plasminogen. Aortic diseases with chronic consumption coagulopathy may lead to disseminated intravascular coagulation (DIC) and cause fatal bleeding. Although the use of antifibrinolytic agents in DIC is generally not recommended due to enhanced fibrin deposition risking thrombotic symptoms, the efficacy of TXA has been reported in several cases of DIC with aortic diseases. However, the efficacy and safety of TXA for bleeding symptoms of chronic consumption coagulopathy with aortic diseases have not been studied in detail. Methods We evaluated the efficacy of TXA in 14 patients with chronic consumptive coagulopathy due to aortic disease complicated by bleeding symptoms. Changes in coagulation and fibrinolysis parameters from baseline were analyzed with Wilcoxon matched-pairs signed-rank tests, excluding missing values. Kaplan-Meier curves were used to analyze overall survival. Results Median age was 78.5 years (range, 66–89 years) and median observation period was 448 days (range, 0–2282 days). Twelve patients had chronic renal failure and 1 patient had chronic liver failure. Before starting treatment, median Japanese Ministry of Health and Welfare DIC diagnostic criteria score was 8 (range, 4–11) and median platelet count was 64 × 109/L (range, 25–97 × 109/L). Twelve patients underwent evaluation of bleeding symptoms after introduction of TXA, and 10 of those 12 patients showed improved bleeding tendencies within 30 days (median, 5.0 days). One patient with chronic liver failure showed worsening of bleeding symptoms. Although only one patient was initiated TXA in combination with anticoagulants, no significant worsening of thrombotic events was observed within 30 days. Conclusions TXA therapy appears effective against chronic consumptive coagulopathy with bleeding due to aortic disease, with few side effects.

The two therapeutic strategies of surgical intervention and medical management in a patient with enhanced-fibrinolytic type of disseminated intravascular coagulation after aortic replacement for Stanford type A aortic dissection with chronic heart and renal failure

“…Several anticoagulant agents have been reported to be effective for DIC, such as heparin [ 6 ], synthetic protease inhibitors [ 7 , 8 ], recombinant soluble thrombomodulin [ 9 ], and direct oral anticoagulants [ 4 , 10 ]. Antifibrinolytic agents such as tranexamic acid are generally not recommended for the DIC due to the increased risk of thromboembolic complications, but it could be a reasonable option in combination with anticoagulant agents for DIC with marked activation of fibrinolysis [ 2 , 11 – 13 , 15 ]. In the first admission of this case, we performed the third sternotomy as the treatment for the underlying disease because the hematoma around the CRT-D was not controlled despite the administration of recombinant soluble thrombomodulin.…”

“…DIC didn't worsen after switching to oral agents. APTTP, activated partial thromboplastin time; AT3, antithrombin III; CRT-D, cardiac resynchronization therapy-defibrillator; DIC, disseminated intravascular coagulation; FDP, fibrinogen degradation products; PAI-1, plasminogen activator inhibitor-I; PIC, plasmin-α2-plasimin inhibitor complex; PT, prothrombin time; SF, soluble fibrin; TAT, thrombin-antithrombin complex complications, but it could be a reasonable option in combination with anticoagulant agents for DIC with marked activation of fibrinolysis [2,[11][12][13]15]. In the first admission of this case, we performed the third sternotomy as the treatment for the underlying disease because the hematoma around the CRT-D was not controlled despite the administration of recombinant soluble thrombomodulin.…”