A Case of Acute Aortic Dissection with Chronic Consumption Cogulopathy Successfully Treated with Antifibrinolytic Therapy

Abstract

An 80-year old man with a history of abdominal aortic aneurysm was emergently admitted to our hospital with suspected ileus. The previous day he had had back pain and abdominal pain. A chest X-ray film showed widening of the aortic shadow. A computed tomography scan with contrast enhancement revealed aortic dissection (Stanford B, De Bakey IIIb). We started conservative hypotensive therapy with nicardipine, without operation or stent grafting, because of the involvement of the major branches of the aortic arch. However, the false lumen was not thrombosed during conservative therapy. Three months later a computed tomography scan with contrast enhancement revealed aortic dissection with a false lumen from the left subclavian artery through the level of the diaphragm. Petechiae were noted over the skin of the thorax and abdomen. Coagulation studies revealed a low platelet count and increased levels of fibrin degradation products and thrombin-antithrombin, indicating disseminated intravascular coagulation due to chronic consumption coagulopathy associated with aortic dissection. Because the bleeding tendency persisted in spite of the initial hypotensive therapy and blood transfusion, we began antifibrinolytic therapy with tranexamic acid. After the antifibrinolytic therapy, the platelet count and levels of fibrinogen and fibrinogen degradation products improved, and the false lumen of the aortic dissection was thrombosed. We conclude that antifibrinolytic therapy with tranexamic acid is effective for treating disseminated intravascular coagulation and for thrombosing the false lumen of aortic dissection.