Preoperative disseminated intravascular coagulation associated with aortic aneurysms.
BACKGROUND
To report clinical experiences with disseminated intravascular coagulation (DIC) associated with aortic aneurysms (AA) and discuss therapeutic strategy.


METHODS



METHODS
uncontrolled, observational study in a university hospital.


METHODS
among 547 patients with AA treated between 1991 and 1999, 10 patients (7 males, 3 females, mean age 68.5+/-2.5) presenting a preoperative DIC score (defined by the Ministry of Health and Welfare in Japan) of 6 or higher were analyzed. The etiology was dissection for 5 and non-dissection for 5 patients. Six of 10 patients had a bleeding tendency. Eight patients received preoperative anticoagulant therapy. Prosthetic replacement was undertaken for 8 patients except for 2 patients in poor condition.


RESULTS
There were no operative deaths in 8 surgical cases. One non-surgical case died of deteriorated bleeding tendency. The mean DIC score was 8.0+/-0.6 at admission, which was reduced to 4.4+/-0.5 at discharge (p<0.05). Prothrombin time, platelet counts, and fibrinogen levels tended to be normalized by the 7th postoperative day. Serum FDP levels decreased with surgery, but tended to increase at the time of discharge and the later follow-up period. Hematologic disturbances and bleeding tendency recurred in 2 patients in the follow-up period.


CONCLUSIONS
In the majority of patients presenting DIC with aortic aneurysm, surgical treatment can be performed safely if adequately managed by anticoagulant therapy. Consumptive coagulopathy usually resolved after surgical intervention, but some patients developed DIC in the later period. If DIC recurs, it is essential to search for contributory causes.
Sasaki
S
S
Department of Cardiovascular Surgery, Hokkaido University School of Medicine, N-14, W-5, Kita-ku, Sapporo, Japan 0608648. sasakish@med.hokudai.ac.jp
Fukada
Y
Y
Kunihara
T
T
Shiiya
N
N
Matsui
Y
Y
Yasuda
K
K
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D001014:Aortic Aneurysm / Q000150:complications* / Q000601:surgery; D016009:Chi-Square Distribution; D004211:Disseminated Intravascular Coagulation / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants