Yamada Shinya, Ueda Hideyasu, Suga Yukio, Miyamoto Toshihiro, Asakura Hidesaku
Department of Hematology, Kanazawa University Hospital, Kanazawa, Japan.
Department of Cardiovascular Surgery, Kanazawa University Hospital, Kanazawa, Japan.
Medicine (Baltimore). 2025 Jul 25;104(30):e43123. doi: 10.1097/MD.0000000000043123.
Aortic aneurysms are often accompanied by enhanced-fibrinolytic-type disseminated intravascular coagulation (DIC), but markers to adequately assess DIC status remain lacking.
An 80-year-old man scheduled for thoracic endovascular aortic repair for aortic aneurysm was diagnosed with enhanced-fibrinolytic-type DIC. The concern was whether surgery could be safely performed in a state of enhanced-fibrinolytic-type DIC with a bleeding tendency.
He was treated with a combination of heparin and tranexamic acid.
DIC was well controlled and the surgery was performed safely. However, DIC worsened again postoperatively. Since no severe bleeding symptoms were observed, no therapeutic intervention for DIC was performed postoperatively. During this period, coagulation tests including factor XIII activity and haptoglobin were followed over time to clarify the relevance of these markers.Factor XIII activity was decreased and haptoglobin was mildly decreased in DIC. Improvement of DIC led to normalization of both markers. Re-exacerbation of DIC led to decreased factor XIII activity and mildly decreased haptoglobin.
Factor XIII activity and haptoglobin appear to represent useful markers of DIC status.
主动脉瘤常伴有纤维蛋白溶解增强型弥散性血管内凝血（DIC），但仍缺乏能充分评估DIC状态的标志物。
一名80岁男性因主动脉瘤计划接受胸段血管腔内主动脉修复术，被诊断为纤维蛋白溶解增强型DIC。担心的是在有出血倾向的纤维蛋白溶解增强型DIC状态下能否安全进行手术。
对他采用肝素和氨甲环酸联合治疗。
DIC得到良好控制，手术安全进行。然而，术后DIC再次恶化。由于未观察到严重出血症状，术后未对DIC进行治疗干预。在此期间，随时间跟踪包括因子 XIII 活性和触珠蛋白在内的凝血试验，以阐明这些标志物的相关性。在DIC中，因子 XIII 活性降低，触珠蛋白轻度降低。DIC的改善导致这两种标志物均恢复正常。DIC再次加重导致因子 XIII 活性降低，触珠蛋白轻度降低。
因子 XIII 活性和触珠蛋白似乎是DIC状态的有用标志物。
