Use of tranexamic acid for disseminated intravascular coagulation with excessive fibrinolysis associated with aortic dissection in a patient with chronic renal failure

Excerpt

Disseminated intravascular coagulation (DIC) is characterized by systemic activation of coagulation, which leads to the intravascular formation of fibrin and depletion of platelets and coagulation factors [1]. Secondary fibrinolysis is seen in patients with DIC, but the degree to which the fibrinolytic system activated varies according to underlying diseases. Aortic aneurysm and aortic dissection are rare but well-recognized causes of DIC [2‐4]; however, the degree of activation of fibrinolytic system seems to differ and the optimal medical treatment strategy, especially in inoperable cases, has not been established yet. Furthermore, there have been few reports which referred to the DIC treatment in patients with renal failure and optimal treatment such as the choice and the dosage of drugs in these conditions is unclear. We report here a case of chronic DIC accompanied by excessive fibrinolytic activity with marked bleeding tendency due to inoperable aortic dissection in a patient with chronic kidney disease under hemodialysis, which was successfully controlled by combined use of tranexamic acid (TA, an antifibrinolytic agent) and anticoagulant. …