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CURRENT ISSUETHE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Frequency: Bi-Monthly

ISSN 0021-9509

Online ISSN 1827-191X

 

The Journal of Cardiovascular Surgery 2001 October;42(5):595-9

CARDIAC SECTION 

    ORIGINAL ARTICLES

Preoperative disseminated intravascular coagulation associated with aortic aneurysms

Sasaki S., Fukada Y., Kunihara T., Shiiya N., Matsui Y., Yasuda K.

From the Depart­ment of Car­di­o­vas­cular Sur­gery Hok­kaido Uni­ver­sity ­School of Med­i­cine, Sap­poro, ­Japan

Back­ground. To ­report clin­ical expe­ri­ences ­with dis­sem­i­nated intra­vas­cular coag­u­la­tion (DIC) asso­ciated ­with ­aortic aneu­rysms (AA) and dis­cuss ther­a­peutic ­strategy.
­Methods. ­Design and set­ting: uncon­trolled, obser­va­tional ­study in a uni­ver­sity hos­pital. ­Patients: ­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.

language: English


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