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.

Keywords: aortic dissection; disseminated intravascular coagulation; tranexamic acid.

Figure 1.

Images of enhanced CT. Enhanced CT was taken before discharge (a-c) and one year later (d). The entry of the false lumen is indicated by black arrows (a, b). The distal re-entry is located at the bifurcation of the iliac arteries. Thrombus formation (white arrow) developed within 1 year, but the false lumen remained open (c, d). CT: Computed tomography

Figure 2.

Time-course of treatment. Treatments (a) in the hospital and (b) at the outpatient clinic. The patient was successfully treated and discharged after 157 days of hospitalization. Briefly, the consumption of coagulation factors and fibrinogen could be not suppressed by anti-coagulation therapies except by continuous infusion of dalteparin. However, once bleeding occurred, it was difficult to resume infusion. The patient developed two hematomas after using FFP prior to shunt operations. Nevertheless, tranexamic acid quickly improved her condition. After discharge, her symptoms remain controlled with 2,000 mg of tranexamic acid per day. RBCs: red blood cells, Fib: fibrinogen, PLTs: platelets, FFP: freshly frozen plasma, I.V.: intravenous administration, S.C.: subcutaneous administration. AST: aspartate aminotransferase, ALT: alanine aminotransferase, LDH: lactate dehydrogenase