Coagulation parameters as predictors of DIC in patients with intact aortic aneurysm

M. M. Jeleńska

doi:10.1055/s-0037-1619626

Hämostaseologie, Table of Contents

Hamostaseologie 2004; 24(03): 162-166
DOI: 10.1055/s-0037-1619626

In eigener Sache

Schattauer GmbH

Coagulation parameters as predictors of DIC in patients with intact aortic aneurysm

Gerinnungsparameter als Prädiktoren einer DIC bei Patienten mit intaktem Aortenaneurysma

M. M. Jeleńska

¹Department of General, Vascular and Transplant Surgery (Head: Prof. Dr. med. J. Szmidt), Medical University of Warsaw, Poland

› Author Affiliations

Abstract

Summary

Clinically overt, preoperative, disseminated intravascular coagulation (DIC) is not common in patient with aortic aneurysm. However, cases with large and expanding aneurysm are especially prone for this coagulopathy. Contrary to the clinically overt form compensated DIC in patients with aortic aneurysm seems frequent and is probably underdiagnosed. The compensated DIC may be recognized, even without bleedings, by laboratory tests documenting the activated coagulation and fibrinolysis. We show that in about one third of patients with abdominal aorta aneurysm (AAA) compensated DIC can be identified. This enables the application of preoperative anticoagulation treatment to improve the intraoperative haemostasis.

Zusammenfassung

Eine klinisch manifeste, präoperative, disseminierte intravasale Gerinnung (DIC) tritt bei Patienten mit einem Aortenaneurysma nicht häufig auf. Patienten mit großem und wachsendem Aneurysma sind für diese Koagulopathie jedoch besonders anfällig. Im Gegensatz zur klinisch manifesten Verbrauchskoagulopathie ist eine kompensierte DIC bei Patienten mit Aortenaneurysma offenbar häufig und wird wahrscheinlich zu selten diagnostiziert. Die kompensierte DIC kann auch ohne Auftreten von Blutungen mit Hilfe von Labortests erkannt werden, die die aktivierte Gerinnung und Fibrinolyse belegen. Wir weisen nach, dass bei etwa einem Drittel der Patienten mit abdominellem Aortenaneurysma (AAA) eine kompensierte DIC erfasst werden kann. Dies ermöglicht die Anwendung einer präoperativen Therapie mit Antikoagulanzien, um die intraoperative Hämostase zu verbessern.

Keywords

DIC - aortic aneurysm - coagulation

Schlüsselwörter

DIC - Aortenaneurysma - Gerinnung

Full Text

References

References
1 Aboulafia DM, Aboulafia ED. Aortic aneurysm-induced disseminated intravascular coagulation. Ann Vasc Surg 1996; 10: 396-405.
2 Aramoto H, Shigematsu H, Muto T. Perioperative changes in coagulative and fibrinolytic function during surgical treatment of abdominal aortic aneurysm and arteriosclerosis obliterans. Intern J Cardiol 1994; (Suppl. 47) 55-63.
3 Balduini CL, Salvini M, Montani N. et al. Activation of hemostatic process in patients with unruptured aortic aneurysm before and in the first week after surgical repair. Haematologica 1997; 82: 581-3.
4 Bieger R, Vreeken J, Stibbe J. et al. Arterial aneurysm as a cause of consumption coagulopathy. New Engl J Med 1971; 258: 152-4.
5 Bradbury A, Adam D, Garrioch M. et al. Changes in platelet count, coagulation and fibrinogen associated with elective repair of asymptomatic abdominal aortic aneurysm and aortic reconstruction for occlusive disease. Eur J Vasc Endovasc Surg 1997; 13: 375-80.
6 Collins GJ, Rich NM, Scialla S. et al. Pitfalls in peripheral vascular surgery: disseminated intravascular coagulation. Am J Surgery 1977; 134: 375-80.
7 Fine NL, Applebaum J, Elguezabal A. et al. Multiple coagulation defects in association with dissecting aneurysm. Arch Intern Med 1967; 119: 522-6.
8 Fisher Jr DF, Yawn DH, Crawford ES. Preoperative disseminated intravascular coagulation associated with aortic aneurysms. Arch Surg 1983; 118: 1252-5.
9 Gertler JP, Cambria RP, Brewster DC. et al. Coagulation changes during thoracoabdominal aneurysm repair. J Vasc Surgery 1996; 24: 936-45.
10 Goto H, Kimoto A, Kawaguchi H. et al. Surgical treatment of abdominal aortic aneurysm complicated with chronic disseminated intravascular coagulopathy. J Cardiovasc Surg 1985; 26: 280-2.
11 Hassen-Khodja R, Sala F, Bouillanne PJ. et al. Impact of aortic diameter on the outcome of surgical treatment of abdominal aortic aneurysm. Ann Vasc Surg 2001; 15: 136-9.
12 Kazmier FJ, Didisheim P, Fairbanks VF. et al. Intravascular coagulation and arterial disease. Thromb Diath Haemorrh 1969; (Suppl. 36) 295-303.
13 Levy PJ, Tabares AH, Olin JW. et al. Disseminated intravascular coagulation associated with acute ischemic hepatitis after elective aortic aneurysm repair: comparative analysis of 10 cases. Cardiothorac Vasc Anesth 1997; 11: 141-8.
14 Macneily AE, Graham AM. Coagulopathy induced by aortoiliac aneurysms. Can J Surg 1988; 31: 27-30.
15 Mamiya S, Endo Y, Miura AB. et al. Disseminated intravascular coagulation accompanying thoracic and abdominal aortic aneurysm; Report of three cases. Jpn J Med 1988; 27: 91-5.
16 Milne AA, Adam DJ, Murphy WG. et al. Effects of asymptomatic abdominal aortic aneurysm on the soluble coagulation system, platelet count and platelet activation. Eur J Vasc Endovasc Surg 1999; 17: 434-7.
17 Milne AA, Drummond GB, Paterson DA. et al. Disseminated intravascular coagulation after aortic aneurysm repair, intraoperative salvage autotransfusion, and aprotinin. Lancet 1994; 344: 470-1.
18 Miyata T, Tada Y, Takagi A. et al. Disseminated intravascular coagulation caused by abdominal aortic aneurysm. J Cardiovascular Surg 1988; 29: 494-7.
19 Mulcare RJ, Royster TS, Weiss HJ. et al. Disseminated intravascular coagulation as a complication of abdominal aortic aneurysm repair. Ann Surg. 1974; 180: 343-9.
20 Müller-Berghaus G. Current and future options in clinical management of DIC. Intern Congress Portugal. 2000
21 Müller-Berghaus G. Disseminated intravascular coagulation: clinical spectrum and established as well as new diagnostic approaches. Thromb Haemost 1999; 82: 706-12.
22 Nikapota ADB, Stern SCM. Bruising in a man with aortic aneurysm. J Royal Soc Med 2002; 95: 556-7.
23 Oba J, Shiya N, Matsui Y. et al. Preoperative disseminated intravascular coagulation (DIC) associated with aortic aneurysm – does it need to be corrected before surgery?. Surg Today 1995; 25: 1011-4.
24 Satiani B, Savrin R, Evans WE. Consumption coagulopathy associated with arterial aneurysm. J Cardiovasc Surg 1979; 20: 273-8.
25 Shortell CK, Illig KA, Ouriel K. Perioperative hemorrhage. In: Vascular Surgery. Philadelphia, London, Sydney, Toronto: W.B. Saunders Company; 2000
26 Siebert WT, Natelson EA. Chronic consumption coagulopathy accompanying abdominal aortic aneurysm. Arch Surg 1976; 111: 539-41.
27 Taylor Jr FB, Toh C-H, Hoots WK. et al. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001; 86: 1327-30.
28 Thompson R, Adams DH, Cohen JR. et al. Disseminated intravascular coagulation caused by abdominal aortic aneurysm. J Vasc Surg 1986; 4: 184-6.
29 Utoh J, Kunitomo R, Hara M. et al. Consumption coagulopathy associated with aneurysms of the abdominal aorta and the bilateral femoral arteries. J Cardiovasc Surg 2001; 42: 245-8.
30 Wada H, Gabazza E, Nakasaki T. et al. Diagnosis of disseminated intravascular coagulation by hemostatic molecular markers. Sem Thromb Hemost 2000; 36: 17-21.
31 Yamazumi K, Ojiro M, Okumura H. et al. An activated state of blood coagulation and fibrinolysis in patients with abdominal aortic aneurysm. Am J Surg 1998; 175: 297-301.