Tranexamic Acid Ameliorated Bleeding Tendency in Abdominal Aortic Aneurysm-Induced Chronic Disseminated Intravascular Coagulation

Abstract

An 84-year-old man with a history of cerebral infarction, inoperable abdominal aortic aneurysm (AAA), and chronic kidney disease-related anemia was admitted for rehabilitation. He had experienced recurrent gastrointestinal bleeding before admission, initially attributed to dual antiplatelet therapy. After admission, progressive subcutaneous hemorrhage developed, prompting detailed coagulation-fibrinolysis testing, which confirmed chronic disseminated intravascular coagulation (DIC) (enhanced-fibrinolytic type) secondary to AAA. Given his advanced age and overall condition, oral tranexamic acid was initiated, resulting in hemorrhage improvement and stabilization of coagulation parameters. Retrospective evaluation suggested that prior gastrointestinal bleeding episodes were more likely attributable to chronic DIC. This case highlights the importance of considering chronic DIC in patients with recurrent, unexplained bleeding, even when they have been evaluated by multiple specialists, and suggests that individualized antifibrinolytic therapy, although not standard, may serve as a practical and familiar option for general internists in carefully selected inoperable elderly patients.

Keywords: abdominal aortic aneurysm; bleeding tendency; chronic disseminated intravascular coagulation; enhanced-fibrinolytic type; tranexamic acid.

Figure 1. Abdominal CT showing a large aortic aneurysm.

Coronal abdominal CT image taken 18 days prior to admission, demonstrating a large abdominal aortic aneurysm (arrows) with a diameter of 68.8 mm.

Figure 2. Subcutaneous hemorrhage associated with chronic fibrinolytic-type disseminated intravascular coagulation.

(A) Subcutaneous hemorrhage extending from the right upper to the lower arm on hospital day 38. (B) Resolution of the hemorrhage following the initiation of oral tranexamic acid.

Figure 3. Clinical course, treatment, and changes in coagulation markers.

Timeline of treatment interventions and corresponding changes in coagulation markers throughout the hospital stay. DAPT: dual antiplatelet therapy; SAPT: single antiplatelet therapy.