PMC6466910_01
Contrast-enhanced axial CT findings showing aortic aneurysm/dissection in (a) Patient 1, showing a stent graft in the descending aorta; (b) Patient 2, showing a stent graft in the descending aorta; (c) Patient 3, showing aneurysms in the bilateral common and internal iliac arteries; and (d) Patient 4, showing an aneurysm in the descending aorta.
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Patient 1 was an 84-year-old woman who had undergone thoracic endovascular aortic repair (TEVAR) for an aortic dissected aneurysm (Figure 1(a)) and was hospitalized for thrombocytopenia and abnormal coagulation. TEVAR for a Stanford type B aortic dissection 7 months earlier (Figure 1(b)). Thereafter, he was sent to a rehabilitation center, where his plasma FDP and D-dimer increased gradually, while fibrinogen and platelet count decreased, and anemia progressed. Enhanced CT revealed bilateral iliac aneurysms, with the right and left aneurysms having maximum diameters of 60.5 mm and 43.7 mm, respectively (Figure 1(c)). Eventually, she was identified with an aortic aneurysm (Figure 1(d)), and hemostasis laboratory abnormalities were attributed to be related to her aortic aneurysm.
Clinical course correlation of treatment and improvement of DIC-related data in Patient 1. (Vertical axis) FDP = fibrin degradation product (microg/ml); D-dimer (microg/ml); fibrinogen (mg/dl); Plt = platelet count (x10e4/microl). (Horizontal axis) days; Hp = heparin: Hp1 = continuous intravenous infusion (10,000 U/day), Hp2 = continuous intravenous infusion (8,000 U/day), and Hp3 = subcutaneous administration (5,000 U twice daily); TA = tranexamic acid: TA1 = intravenous infusion (250 mg twice daily),  = intravenous TA (250 mg twice daily) + oral TA (750 mg/day), TA2 = oral (750 mg/day), and TA3 = oral (1500 mg/day); WF = warfarin oral; RIV = rivaroxaban oral (15 mg/day).
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This combination treatment was effective as her plasma FDP and D-dimer concentrations decreased while her fibrinogen level and platelet count increased (Figure 2).
Clinical course correlation of treatment and improvement of DIC-related data in Patient 2. (Vertical axis) FDP = fibrin degradation product (microg/ml); D-dimer (microg/ml); fibrinogen (mg/dl); Plt = platelet count (x10e4/microl). (Horizontal axis) days; Hp = heparin: Hp3 = subcutaneous administration (5,000 U twice daily); TA3 = oral (1500 mg/day); RIV = rivaroxaban oral (15 mg/day).
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Later, he was successfully switched to oral rivaroxaban (15 mg/day) as maintenance treatment at the outpatient clinic (Figure 3).