Haemorrhage associated with large abdominal aortic aneurysms

Two patients are described who each had a major haemorrhage after minor surgery and who additionally had large abdominal aortic aneurysms. Neither had depletion of platelets or coagulation factors sufficient to account for bleeding. Both had grossly enhanced fibrinolytic activity with evidence of plasmin generation in the circulation. In one patient insertion of an aortic graft was rapidly followed by resolution of the fibrinolytic abnormalities. Overactive fibrinolysis, rather than coagulation factor consumption may account for some of the bleeding syndromes complicating abdominal aortic aneurysms.