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Preoperative disseminated intravascular coagulation associated with aortic aneurysms. A prospective study of 76 cases
Insights
Clinically overt disseminated intravascular coagulation (DIC) is rare in patients with aortic aneurysms before surgery. Hemostatic abnormalities are key diagnostic indicators for this condition.
Area of Science:
- Vascular Surgery
- Hematology
- Coagulation Disorders
Background:
- Aortic aneurysms are associated with coagulopathies.
- The incidence of disseminated intravascular coagulation (DIC) in patients with aortic aneurysms requires further investigation.
Observation:
- A prospective study evaluated 76 preoperative patients with aortic aneurysms.
- Elevated fibrin split products were observed in 39% of patients.
- Only 4% of patients presented with clinically overt DIC and bleeding diathesis.
Findings:
- Clinically overt disseminated intravascular coagulation (DIC) occurred in only 4% of patients.
- Patients with overt DIC had extensive thoracoabdominal aortic aneurysms.
- Preoperative fibrinogen levels were not reliable indicators of excessive fibrinolysis.
Implications:
- Hemostatic abnormalities like ecchymoses and petechiae are crucial for diagnosing DIC in this patient group.
- Early identification of DIC can guide surgical and anesthetic management.
- Further research into the specific mechanisms of coagulation activation in aortic aneurysms is warranted.
Abstract:
A prospective study of 76 preoperative patients with aortic aneurysms was undertaken to determine the true incidence of associated disseminated intravascular coagulation (DIC). Although 39% of the patients showed a notable elevation of the fibrin split products level, only three had thrombocytopenia and a clinical bleeding diathesis, as well. Thus, clinically overt DIC occurred preoperatively in only 4% of the patients. All three patients had extensive aneurysms that involved the thoracoabdominal aorta. Preoperative fibrinogen levels in this series tended to be high-normal or elevated and were not good indicators of underlying excessive fibrinolysis. Hemostatic abnormalities, such as ecchymoses and petechiae, may be the key to the clinical diagnosis of DIC in preoperative patients with aortic aneurysms.