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Preoperative Disseminated Intravascular Coagulation Associated With Aortic Aneurysms: A Prospective Study of 76 Cases

Preoperative Disseminated Intravascular Coagulation Associated With Aortic Aneurysms: A... 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. (Arch Surg 1983;118:1252-1255) References 1. Mulcare RJ, Royster TS, Phillips LL: Intravascular coagulation in surgical procedures on the abdominal aorta . Surg Gynecol Obstet 1976;143: 730-734. 2. Fine NL, Applebaum J, Elguezabal A, et al: Multiple coagulation defects in association with dissecting aneurysms . Arch Intern Med 1967; 119:522-526.Crossref 3. Siebert WT, Natelson EA: Chronic consumption coagulopathy accompanying abdominal aortic aneurysm . Arch Surg 1976;111:539-541.Crossref 4. Collins GJ, Rich NM, Scialla S, et al: Pitfalls in peripheral vascular surgery: Disseminated intravascular coagulation . Am J Surg 1977;134:375-380.Crossref 5. Satiani B, Savrin R, Evans WE: Consumption coagulopathy associated with arterial aneurysms . J Cardiovasc Surg 1979;20:273-278. 6. Diskin CJ, Weitberg AB: Minidose heparin therapy: Treatment of chronic intravascular coagulation syndrome . Arch Intern Med 1980;140: 263-266.Crossref 7. Keagy BA, Pharr WF, Bowes DE: Unusual presentations of abdominal aortic aneurysms . J Cardiovasc Surg 1981;22:41-46. 8. Mulcare RJ, Royster TS, Weiss HJ, et al: Disseminated intravascular coagulation as a complication of abdominal aortic aneurysm repair . Ann Surg 1974;180:343-349.Crossref 9. Ten Cate JW, Timmers H, Becker AE: Coagulopathy in ruptured or dissecting aortic aneurysms . Am J Med 1975;59:171-176.Crossref 10. Bieger R, Vreeken J, Stibbe J, et al: Arterial aneurysm as a cause of consumption coagulopathy . N Engl J Med 1971;285:152-154.Crossref 11. Schnetzer GW, Penner JA: Chronic intravascular coagulation syndrome associated with atherosclerotic aortic aneurysm . South Med J 1973;66:264-268.Crossref 12. Fouser LS, Morrow NE, Davis RB: Platelet dysfunction associated with abdominal aortic aneurysm . Am J Clin Pathol 1980;74:701-705. 13. Babu SC, Bole P, Sharma P, et al: Pathological fibrinolysis secondary to pseudoaneurysms . Surgery 1980;87:202-204. 14. Scott J, Humphres DR: Dissecting aortic aneurysm and disseminated intravascular coagulation . Br Med J 1977;1:24.Crossref 15. McLeod AA, Cuddigan BJ, Mahon WE: Chronic haemorrhagic disorder induced by dissecting aortic aneurysm . Eur Heart J 1980;1:409-411. 16. Hens L, Dom R, Goddeeris P, et al: Cerebral disseminated intravascular coagulation in dissecting aortic aneurysm . J Neurol 1981;225: 73-76.Crossref 17. Puxeddu A, Ribacchi R, Scionti L, et al: Disseminated intravascular coagulation in dissecting aortic aneurysm: A case report . Panminerva Med 1981;23:39-42. 18. Rhodes GR, Cox CB, Silver D: Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy . Surgery 1973;73: 535-540. 19. Hardaway RM: What's new: A review of misconceptions concerning fibrinogen . Tex Med 1982;78:40-44. 20. Getaz EP, Louw JH: The coagulopathy associated with aortic aneurysms . Postgrad Med J 1977;53:668-671.Crossref 21. Wilkens HJ, Back N: Fibrinolysis and risk factors of atherosclerotic disease with special emphasis on diabetes mellitus . Circ Shock 1978;5: 125-143. 22. Harker LA, Schwartz SM, Ross R: Endothelium and arteriosclerosis . Clin Haematol 1981;10:283-291. 23. Straub PW: Chronic intravascular coagulation: Localized or generalized? With evidence for thrombus turnover . Thromb Haemost 1973; 56( (suppl) ):1-10. 24. Crawford ES: Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, and celiac arteries . Ann Surg 1974; 179:763.Crossref 25. Crawford ES, Snyder DM, Cho GC, et al: Progress in treatment of thoraco-abdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries . Ann Surg 1978;188:404-422.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Preoperative Disseminated Intravascular Coagulation Associated With Aortic Aneurysms: A Prospective Study of 76 Cases

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References (26)

Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1983.01390110010002
Publisher site
See Article on Publisher Site

Abstract

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. (Arch Surg 1983;118:1252-1255) References 1. Mulcare RJ, Royster TS, Phillips LL: Intravascular coagulation in surgical procedures on the abdominal aorta . Surg Gynecol Obstet 1976;143: 730-734. 2. Fine NL, Applebaum J, Elguezabal A, et al: Multiple coagulation defects in association with dissecting aneurysms . Arch Intern Med 1967; 119:522-526.Crossref 3. Siebert WT, Natelson EA: Chronic consumption coagulopathy accompanying abdominal aortic aneurysm . Arch Surg 1976;111:539-541.Crossref 4. Collins GJ, Rich NM, Scialla S, et al: Pitfalls in peripheral vascular surgery: Disseminated intravascular coagulation . Am J Surg 1977;134:375-380.Crossref 5. Satiani B, Savrin R, Evans WE: Consumption coagulopathy associated with arterial aneurysms . J Cardiovasc Surg 1979;20:273-278. 6. Diskin CJ, Weitberg AB: Minidose heparin therapy: Treatment of chronic intravascular coagulation syndrome . Arch Intern Med 1980;140: 263-266.Crossref 7. Keagy BA, Pharr WF, Bowes DE: Unusual presentations of abdominal aortic aneurysms . J Cardiovasc Surg 1981;22:41-46. 8. Mulcare RJ, Royster TS, Weiss HJ, et al: Disseminated intravascular coagulation as a complication of abdominal aortic aneurysm repair . Ann Surg 1974;180:343-349.Crossref 9. Ten Cate JW, Timmers H, Becker AE: Coagulopathy in ruptured or dissecting aortic aneurysms . Am J Med 1975;59:171-176.Crossref 10. Bieger R, Vreeken J, Stibbe J, et al: Arterial aneurysm as a cause of consumption coagulopathy . N Engl J Med 1971;285:152-154.Crossref 11. Schnetzer GW, Penner JA: Chronic intravascular coagulation syndrome associated with atherosclerotic aortic aneurysm . South Med J 1973;66:264-268.Crossref 12. Fouser LS, Morrow NE, Davis RB: Platelet dysfunction associated with abdominal aortic aneurysm . Am J Clin Pathol 1980;74:701-705. 13. Babu SC, Bole P, Sharma P, et al: Pathological fibrinolysis secondary to pseudoaneurysms . Surgery 1980;87:202-204. 14. Scott J, Humphres DR: Dissecting aortic aneurysm and disseminated intravascular coagulation . Br Med J 1977;1:24.Crossref 15. McLeod AA, Cuddigan BJ, Mahon WE: Chronic haemorrhagic disorder induced by dissecting aortic aneurysm . Eur Heart J 1980;1:409-411. 16. Hens L, Dom R, Goddeeris P, et al: Cerebral disseminated intravascular coagulation in dissecting aortic aneurysm . J Neurol 1981;225: 73-76.Crossref 17. Puxeddu A, Ribacchi R, Scionti L, et al: Disseminated intravascular coagulation in dissecting aortic aneurysm: A case report . Panminerva Med 1981;23:39-42. 18. Rhodes GR, Cox CB, Silver D: Arteriovenous fistula and false aneurysm as the cause of consumption coagulopathy . Surgery 1973;73: 535-540. 19. Hardaway RM: What's new: A review of misconceptions concerning fibrinogen . Tex Med 1982;78:40-44. 20. Getaz EP, Louw JH: The coagulopathy associated with aortic aneurysms . Postgrad Med J 1977;53:668-671.Crossref 21. Wilkens HJ, Back N: Fibrinolysis and risk factors of atherosclerotic disease with special emphasis on diabetes mellitus . Circ Shock 1978;5: 125-143. 22. Harker LA, Schwartz SM, Ross R: Endothelium and arteriosclerosis . Clin Haematol 1981;10:283-291. 23. Straub PW: Chronic intravascular coagulation: Localized or generalized? With evidence for thrombus turnover . Thromb Haemost 1973; 56( (suppl) ):1-10. 24. Crawford ES: Thoraco-abdominal and abdominal aortic aneurysms involving renal, superior mesenteric, and celiac arteries . Ann Surg 1974; 179:763.Crossref 25. Crawford ES, Snyder DM, Cho GC, et al: Progress in treatment of thoraco-abdominal and abdominal aortic aneurysms involving celiac, superior mesenteric, and renal arteries . Ann Surg 1978;188:404-422.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Nov 1, 1983

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