Suzuki Naruko, Suzuki Nobuaki, Kawaguchi Yuka, Okamoto Shuichi, Kanematsu Takeshi, Katsumi Akira, Suzuki Atsuo, Tamura Shogo, Kojima Tetsuhito, Kiyoi Hitoshi, Matsushita Tadashi
Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Transfusion Medicine, Nagoya University Hospital, Nagoya, Japan.
Thromb J. 2023 Jan 25;21(1):10. doi: 10.1186/s12959-022-00429-4.
Tranexamic acid (TXA) is an antifibrinolytic drug that blocks lysine-binding sites on the profibrinolytic enzyme plasminogen. Aortic diseases with chronic consumption coagulopathy may lead to disseminated intravascular coagulation (DIC) and cause fatal bleeding. Although the use of antifibrinolytic agents in DIC is generally not recommended due to enhanced fibrin deposition risking thrombotic symptoms, the efficacy of TXA has been reported in several cases of DIC with aortic diseases. However, the efficacy and safety of TXA for bleeding symptoms of chronic consumption coagulopathy with aortic diseases have not been studied in detail.
We evaluated the efficacy of TXA in 14 patients with chronic consumptive coagulopathy due to aortic disease complicated by bleeding symptoms. Changes in coagulation and fibrinolysis parameters from baseline were analyzed with Wilcoxon matched-pairs signed-rank tests, excluding missing values. Kaplan-Meier curves were used to analyze overall survival.
Median age was 78.5 years (range, 66-89 years) and median observation period was 448 days (range, 0-2282 days). Twelve patients had chronic renal failure and 1 patient had chronic liver failure. Before starting treatment, median Japanese Ministry of Health and Welfare DIC diagnostic criteria score was 8 (range, 4-11) and median platelet count was 64 × 10/L (range, 25-97 × 10/L). Twelve patients underwent evaluation of bleeding symptoms after introduction of TXA, and 10 of those 12 patients showed improved bleeding tendencies within 30 days (median, 5.0 days). One patient with chronic liver failure showed worsening of bleeding symptoms. Although only one patient was initiated TXA in combination with anticoagulants, no significant worsening of thrombotic events was observed within 30 days.
TXA therapy appears effective against chronic consumptive coagulopathy with bleeding due to aortic disease, with few side effects.
氨甲环酸（TXA）是一种抗纤维蛋白溶解药物，可阻断纤维蛋白溶解酶纤溶酶原上的赖氨酸结合位点。患有慢性消耗性凝血病的主动脉疾病可能导致弥散性血管内凝血（DIC）并引起致命性出血。尽管由于纤维蛋白沉积增加有引发血栓形成症状的风险，一般不建议在DIC中使用抗纤维蛋白溶解剂，但已有报道称TXA在几例患有主动脉疾病的DIC病例中有效。然而，TXA对患有主动脉疾病的慢性消耗性凝血病出血症状的疗效和安全性尚未进行详细研究。
我们评估了TXA对14例因主动脉疾病并发出血症状而患有慢性消耗性凝血病患者的疗效。使用Wilcoxon配对符号秩检验分析凝血和纤维蛋白溶解参数相对于基线的变化，排除缺失值。采用Kaplan-Meier曲线分析总生存率。
中位年龄为78.5岁（范围66 - 89岁），中位观察期为448天（范围0 - 2282天）。12例患者患有慢性肾衰竭，1例患者患有慢性肝功能衰竭。开始治疗前，日本厚生劳动省DIC诊断标准中位评分为8分（范围4 - 11分），中位血小板计数为64×10⁹/L（范围25 - 97×10⁹/L）。12例患者在引入TXA后接受了出血症状评估，其中10例患者在30天内（中位时间为5.0天）出血倾向得到改善。1例慢性肝功能衰竭患者出血症状恶化。尽管仅1例患者开始联合使用TXA和抗凝剂，但在30天内未观察到血栓形成事件有明显恶化。
TXA治疗似乎对因主动脉疾病导致出血的慢性消耗性凝血病有效，且副作用较少。
