Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum - University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany.
Hamostaseologie. 2019 Aug;39(3):294-297. doi: 10.1055/s-0038-1675386. Epub 2018 Nov 19.
Characteristic features of disseminated intravascular coagulation (DIC) are the opposing risks of bleeding (due to consumptive coagulopathy and hyperfibrinolysis) and organ failure (due to widespread microvascular thromboses). The purpose of anticoagulation in DIC is to attenuate excessive thrombin generation and fibrin deposition. While heparins have been shown to be beneficial in this context, the safety and efficacy of direct oral anticoagulants have not yet been sufficiently addressed. Here, we report two patients in whom chronic DIC was stabilized upon administration of apixaban: an elderly male with aortic dissection presenting with significant mucocutaneous bleeding and a younger female with Klippel-Trénaunay-Weber syndrome presenting with multiple superficial vein thromboses (SVTs). In addition to an improvement in DIC parameters, both patients benefited clinically with resolution of bleeding symptoms and prevention of further SVTs, respectively. Oral apixaban thus showed promising safety and efficacy in the management of DIC caused by vascular abnormalities; still further investigations are needed to support these findings.
弥漫性血管内凝血（DIC）的特征是出血（由于消耗性凝血病和纤维蛋白溶解亢进）和器官衰竭（由于广泛的微血管血栓形成）的风险相互对立。DIC 中抗凝的目的是减轻过度的凝血酶生成和纤维蛋白沉积。肝素已被证明在此情况下有益，但直接口服抗凝剂的安全性和有效性尚未得到充分解决。在这里，我们报告了两名接受阿哌沙班治疗后慢性 DIC 得到稳定的患者：一名老年男性，患有主动脉夹层，表现为明显的黏膜皮肤出血；一名年轻女性，患有 Klippel-Trénaunay-Weber 综合征，表现为多处浅表静脉血栓形成（SVT）。除了 DIC 参数的改善外，两名患者的临床症状均得到改善，出血症状得到缓解，分别预防了进一步的 SVT。因此，口服阿哌沙班在治疗由血管异常引起的 DIC 方面显示出良好的安全性和有效性；仍需要进一步的研究来支持这些发现。
