Key result
Treatment with recombinant thrombomodulin and tranexamic acid successfully ameliorated bleeding symptoms and facilitated hemostasis during hemodialysis in a patient with chronic DIC.
Case Report (n=1)
No
The combination of recombinant thrombomodulin and tranexamic acid may be an effective and safe medical treatment for severe bleeding due to chronic DIC and secondary factor XIII deficiency in dialysis patients with unoperable aortic aneurysms.
May aid bleeding control during hemodialysis in chronic DIC; hypothesis-generating case report requiring prospective validation.
69歳男性, 胸部解離性大動脈瘤の既往があるが, 保存的に経過観察されていた. X−2年に腎硬化症による末期腎不全のため内シャント造設術施行. 術中の止血に難渋し, 後日再開創・血腫除去術を要した. 血液透析導入後も出血症状が目立ち, シャント穿刺部止血困難が頻回にみられた. X−5週に誤咬のため頬粘膜血腫を形成し外来治療を行うも, 血腫増大傾向のため入院した. 頬粘膜の縫合術を施行したが血腫増大は続いた. 入院第9病日には誘因なく背部に巨大皮下血腫を形成した. 血液検査より解離性大動脈瘤による慢性播種性血管内凝固症候群 (disseminated intravascular coagulation: DIC) の増悪と後天性血友病XIIIによる出血症状と考えた. 外科的介入は困難で, 輸血に加えてトラネキサム酸 (tranexamic acid: TXA) と遺伝子組み換えトロンボモジュリン製剤 (recombinant thrombomodulin: rTM) 投与を行い出血症状は改善した. その後透析後の止血困難も改善し大動脈瘤に対する根治術を行うことなく維持透析を継続できた.
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Suzuki et al. (2020) conducted a case report in Chronic DIC associated with an aortic aneurysm and secondary factor XIII deficiency (n=1). Recombinant thrombomodulin and tranexamic acid was evaluated on Resolution of bleeding symptoms and achievement of hemostasis during hemodialysis. Treatment with recombinant thrombomodulin and tranexamic acid successfully ameliorated bleeding symptoms and facilitated hemostasis during hemodialysis in a patient with chronic DIC.
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