Tranexamic Acid Controlled Chronic Disseminated Intravascular Coagulation Associated with Aortic Dissection and Patent False Lumen for Three Years

Abstract

The management of chronic disseminated intravascular coagulation (DIC) caused by aortic dissection has not yet been established. Even in cases where surgical correction is performed, therapeutic control of systemic hemorrhaging is still required. We herein report the successful treatment of a case of aortic dissection with a patent false lumen using tranexamic acid for acute exacerbation of chronic DIC. Oral administration of 1,500 mg tranexamic acid per day stabilized the coagulative and fibrinolytic parameters and relieved bleeding tendencies with no side effects. Heparin was administered periodically for the management of hemodialysis. This favorable result continued for up to 3 years.

Oral tranexamic acid combined with low molecular weight heparin only during dialysis sessions successfully controlled chronic disseminated intravascular coagulation associated with aortic aneurysm and aortic dissection in a dialysis patient: a case report with literature review

“…Successful reports of tranexamic acid in aortic DIC patients on hemodialysis have shown good results, with orally 0.5-2.0 g tranexamic acid daily [2,12]. In contrast to the abovementioned cases on peritoneal dialysis with the adverse reactions, no adverse effects were identified, despite the use of higher dosages than recommended for nondialysis-dependent chronic kidney disease patients with the same level of eGFR.…”

“…There are only few reported cases requiring hemodialysis with DIC induced by aortic aneurysm or aortic dissection, in which tranexamic acid was administered [2,12,23] ( Table 2). No one received surgical procedures for aortic aneurysms or aortic dissections.…”

“…In some patients with enhanced fibrinolytic-type DIC, the combined use of antifibrinolytic agents, such as tranexamic acid, with anticoagulants has shown clinical effectiveness [2][3][4]. However, antifibrinolytic therapy is generally contraindicated in DIC [3,5].…”

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

“…While surgical treatment for vascular diseases is frequently performed to improve DIC, it is often difficult for elderly or frail patients to undergo surgery because of its invasiveness. In patients unsuited for surgery, medical treatments have been performed, such as blood transfusion, a combination anticoagulant therapy of heparins and tranexamic acid ( 3 - 5 ), and recombinant thrombomodulin (rTM) ( 6 - 9 ). However, these treatments require long-term hospitalization or frequent hospital visits, which reduce patients' quality of life.…”

Successful treatment of disseminated intravascular coagulation associated with aortic dissection

“…Several treatments of DIC from aortic dissection have been reported. 1 , 2 , 3 , 4 , 5 , 6 , 7 Although surgical intervention is sometimes necessary for dilation of the dissecting aortic aneurysm, optimal medical therapy is recommended because of the high risk of surgical repair for bleeding tendency. In addition, endovascular repair for Stanford type B aortic dissection is currently performed frequently and safely.…”