[A case of medically treated type A acute aortic dissection: trial of antifibrinolytic therapy while monitoring the thrombotic and fibrinolytic parameters].
A 56-year-old male was admitted with severe chest and abdominal pain. Enhanced CT revealed type-A acute aortic dissection. Enhancement of false lumen was complete in the aortic arch, but it was incomplete in the ascending and descending aorta. This finding suggested a thrombosing tendency of the false lumen. Marked elevation of Thrombin-Antithrombin III complex (TAT) and Plasmin-alpha 2 Plasmin inhibitor complex (PIC) indicated the activation of both coagulation and fibrinolysis in the false lumen. Aprotinin and Tranexamic acid were used in order to suppress the fibrinolysis. Both TAT and PIC were completely normalized at the 20th hospital day. Enhanced CT on the 40th hospital day showed that the false lumen had disappeared, and the adventitia had thickened. Care should be taken to notice activated coagulation and fibrinolysis in the false lumen. This report appears to be the first statement about the effectiveness of antifibrinolytic therapy to facilitate thrombosing and healing of the false lumen in the treatment of acute aortic dissection.
Tsushima
Y
Y
Department of Surgery, Cardiovascular Center Sakakibara Hospital.
Hata
T
T
Namba
H
H
Sone
Y
Y
Tezuka
M
M
Shinozaki
M
M
Murakami
T
T
Hamanaka
S
S
Taniguchi
G
G
D000208:Acute Disease; D000784:Aortic Dissection / Q000097:blood / Q000188:drug therapy*; D000933:Antifibrinolytic Agents / Q000032:analysis / Q000627:therapeutic use*; D000990:Antithrombin III / Q000032:analysis; D001014:Aortic Aneurysm / Q000097:blood / Q000188:drug therapy*; D007611:Aprotinin / Q000627:therapeutic use; D001777:Blood Coagulation; D005341:Fibrinolysin / Q000032:analysis; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010447:Peptide Hydrolases / Q000032:analysis; D014148:Tranexamic Acid / Q000627:therapeutic use; D000979:alpha-2-Antiplasmin
D000933:Antifibrinolytic Agents; D000979:alpha-2-Antiplasmin; C046193:antithrombin III-protease complex; C037742:plasmin-plasmin inhibitor complex; D014148:Tranexamic Acid; D000990:Antithrombin III; D007611:Aprotinin; D010447:Peptide Hydrolases; D005341:Fibrinolysin