Therapy of the Kasabach-Merritt syndrome with cryoprecipitate plus intra-arterial thrombin and aminocaproic acid.
A patient with the Kasabach-Merritt syndrome with disseminated intravascular coagulopathy and congestive heart failure due to a giant hepatic cavernous hemangioma achieved thrombosis of his tumor with a combination of cryoprecipitate plus intra-arterial thrombin and epsilon aminocaproic acid. This was documented by an absence of Indium 111-labelled platelet sequestration, marked decrease in thrombin:antithrombin complex generation, and normalization of platelet count and fibrinogen. Interventional angiography with aminocaproic acid and thrombin is advocated in patients whose tumors are amenable to such an approach so as to avoid a systemic antifibrinolytic state.
Stahl
R L
RL
Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
Henderson
J M
JM
Hooks
M A
MA
Martin
L G
LG
Duncan
A
A
D000368:Aged; D000614:Aminocaproates / Q000627:therapeutic use*; D000990:Antithrombin III / Q000378:metabolism; D001778:Blood Coagulation Disorders / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005169:Factor VIII / Q000627:therapeutic use*; D005340:Fibrinogen / Q000378:metabolism / Q000627:therapeutic use*; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology; D006391:Hemangioma / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D008297:Male; D010447:Peptide Hydrolases / Q000378:metabolism; D010976:Platelet Count; D013577:Syndrome; D013917:Thrombin / Q000627:therapeutic use*; D013921:Thrombocytopenia / Q000097:blood / Q000150:complications / Q000188:drug therapy*
D000614:Aminocaproates; C046193:antithrombin III-protease complex; C026912:cryoprecipitate coagulum; D000990:Antithrombin III; D005169:Factor VIII; D005340:Fibrinogen; D010447:Peptide Hydrolases; D013917:Thrombin