Effective treatment with para-aminomethylbenzoic acid for chronic disseminated intravascular coagulation associated with aortic dissection

Management of disseminated intravascular coagulation after thoracic endovascular aortic repair of type B aortic dissection: a case report

Background

Disseminated intravascular coagulation (DIC) is a critical and rare complication after thoracic endovascular aortic repair (TEVAR) of type B aortic dissection. The optimal treatment of aortic dissection-related DIC remains controversial.

Case presentation

We herein describe the successful management of a 65-year-old man who presented with gingival bleeding and multiple subcutaneous petechiae and was proven to have DIC after TEVAR of aortic dissection. The patient had initially been discharged with improved laboratory tests after anticoagulation treatment followed by oral rivaroxaban for maintenance. However, he was readmitted with recurrent gingival bleeding 17 days later. The DIC was successfully controlled with a combination of anticoagulation and antifibrinolytics. After the patient was discharged, his treatment was switched to oral tranexamic acid and warfarin for maintenance. During a 15-month follow-up, the patient had no recurrence of hemorrhage symptoms and maintained stable coagulative and fibrinolytic parameters.

Conclusions

Aortic dissection-related DIC requires long-term management under conservative treatment. The combination of warfarin and tranexamic acid may be a feasible method for long-term maintenance therapy.

Furanonyl amino acid derivatives as hemostatic drugs: design, synthesis and hemostasis performance

Using 3,4-dihalo-2(5H)-furanones and easily available hemostatic drugs, such as tranexamic acid (TA), 4-aminomethylbenzoic acid (ABA), aminocaproic acid (AA) as starting materials, serial multi-functional molecules 2(5H)-furanonyl amino acids are designed by the combination of different pharmacophores, and successfully synthesized by a transition metal-free Michael addition-elimination reaction. The reaction is carried out under mild conditions with ethanol-dichloromethane as solvent and only stirring at room temperature for 24 h, and the yield can be up to 91%. All products are well characterized by infrared spectroscopy (IR), nuclear magnetic resonance (NMR), high-resolution mass spectra (HRMS). Ten typical target compounds among them are selected out for the experiments of hemostasis performance by the evaluation of in vitro clot formation model and liver hemorrhage model. The test results show that, their hemostasis effect is better than the original drugs. Especially the target compound G, a TA derivative from 5-borneoloxy-3,4-dibromo-2(5H)-furanone, has the best hemostasis effect among all the tested compounds. These obtained target molecules are expected to be used as multi-functional hemostatic drugs.

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

A 70-year-old woman was hospitalized for exacerbation of chronic idiopathic thrombocytopenic purpura (ITP) and disseminated intravascular coagulation (DIC) from old aortic dissection. Initially, we increased the dose of prednisolone for ITP. However, her bleeding tendency caused by DIC worsened despite the rapid recovery of her platelet count, and the required amount of fresh-frozen plasma for transfusion increased. The administration of edoxaban for atrial fibrillation led to the marked improvement of her DIC status without serious adverse events. This case suggests that a direct oral anticoagulant may be an effective treatment for DIC caused by aortic dissection.

How an Elevated Creatinine Level Can Deter the Diagnosis of Acute Aortic Dissection

Acute aortic dissection (AAD) classically manifests with sudden, severe chest pain radiating to the back or abdomen, often described as ripping or tearing sensation. Considering its abrupt onset, the diagnosis requires a high index of suspicion prompting immediate imaging using computed tomography (CT) with contrast. However, the use of contrast is a relative contraindication in the patients with renal compromise and acute care physicians are often deterred from contrast use in these patients. Herein, we present an unusual case of hematuria as the presenting symptom of a developing the Stanford type-A AAD. A 65-year-old female presented with sudden, severe chest pain radiating to her lower back. She reported that her urine color was 'pink' on the previous day and was becoming more 'red-colored' as the day progressed. The next morning, she began feeling a 10/10 crushing-type chest pain that was relieved when she lay on her left side and was associated with nausea, vomiting, and diaphoresis. The urine analysis revealed gross hematuria. The laboratory findings revealed a creatinine of 1.3. Due to her elevated creatine levels and possible acute kidney injury, a computed tomography (CT) without contrast was performed initially, which did not reveal an AAD. However, the index of suspicion was still high for the AAD, after prompt discussions about the risk of using contrast and contrast nephropathy versus the risks of potential complications, if AAD was missed. Further evaluation with CT of the chest and abdomen, with contrast, was obtained with the patients' consent, which revealed a Stanford type-A AAD starting proximally from the aortic arch and extending to the common iliac. In conclusion, the clinical presentations of AAD are more heterogeneous. Hematuria in the presence of high index of suspicion and symptoms of AAD could indicate the extension of the involvement of the renal arteries. Prompt CT with contrast may be indicated despite relative contraindications from the laboratory findings.

Chronic disseminated intravascular coagulation induced by left atrial thrombus in a patient with giant "normal" heart: A case report

INTRODUCTION

We herein describe a patient with chronic disseminated intravascular coagulation (DIC) induced by a giant thrombus in the left atrium.A 63-year-old woman was admitted to our hospital for evaluation of extensive mucocutaneous hemorrhage, especially at the sites of venipuncture, on May 21, 2015. Considering her long history of rheumatic heart disease and atrial fibrillation and her mitral valve replacement performed several years previously, we strongly suspected that the bleeding was closely related to postoperative over-anticoagulation of warfarin. After careful investigation, we found that her coagulopathy was induced by the chronic DIC, which was in turn secondary to a left atrial giant thrombus. This is a rarely reported cause of chronic DIC. Cardiac computed tomography and echocardiography showed apparent biatrial enlargement; the morphology and function of the ventricles were unaffected. After anticoagulant therapy, the bleeding tendency and coagulation index were significantly improved.

CONCLUSION

A left atrial thrombus should be considered as a differential diagnosis of chronic DIC, especially in patients with predisposing heart conditions. Because treatment of the underlying cause is paramount in the management of chronic DIC, this case is of great clinical value.