title: Successful treatment of chronic disseminated intravascular coagulation using recombinant human soluble thrombomodulin in a dialysis patient with dissecting aortic aneurysm.
abstract: A 62-year-old man had a history of acute aortic dissection (Stanford type A) and had been diagnosed with polycystic kidney disease three years earlier, and then developed end-stage renal failure. He was referred with chief complaints of difficult hemostasis and consecutive hemorrhagic episodes at the puncture site of the shunt soon after dialysis introduction. We suspected chronic disseminated intravascular coagulation (DIC) due to mild thrombocytopenia and a fibrinolytic system abnormality. Plasma factor XIII activity was decreased, but no inhibitor was detected. In addition, contrast-enhanced computed tomography showed exacerbation of a dissecting aortic aneurysm. We finally diagnosed chronic DIC and secondary factor XIII deficiency associated with the aortic aneurysm. We selected treatment involving recombinant human soluble thrombomodulin (rTM) because he was on maintenance dialysis and required long-term follow-up bofore the operation. Hemostatic function improved with regular administration of rTM, and was well-controlled preoperatively.
authors.affiliation: Department of Internal Medicine, Kinan Hospital.
authors.forename: Kana
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Shinobu
authors.initials: S
authors.lastname: Tamura
authors.forename: Hiroya
authors.initials: H
authors.lastname: Gima
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hayakawa
authors.forename: Toshio
authors.initials: T
authors.lastname: Kurihara
authors.forename: Maki
authors.initials: M
authors.lastname: Ooura
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Nakano
authors.forename: Masayoshi
authors.initials: M
authors.lastname: Souri
authors.forename: Akitada
authors.initials: A
authors.lastname: Ichinose
authors.forename: Tokuzo
authors.initials: T
authors.lastname: Fujimoto
mesh_terms: D000784:Aortic Dissection / Q000150:complications*; D001014:Aortic Aneurysm / Q000150:complications*; D002908:Chronic Disease; D004211:Disseminated Intravascular Coagulation / Q000188:drug therapy* / Q000209:etiology*; D005177:Factor XIII Deficiency / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D007690:Polycystic Kidney Diseases / Q000150:complications; D011994:Recombinant Proteins / Q000627:therapeutic use; D006435:Renal Dialysis; D012995:Solubility; D013921:Thrombocytopenia / Q000150:complications; D018180:Thrombomodulin / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D011994:Recombinant Proteins; D018180:Thrombomodulin