Abstract：
:Characteristic features of disseminated intravascular coagulation (DIC) are the opposing risks of bleeding (due to consumptive coagulopathy and hyperfibrinolysis) and organ failure (due to widespread microvascular thromboses). The purpose of anticoagulation in DIC is to attenuate excessive thrombin generation and fibrin deposition. While heparins have been shown to be beneficial in this context, the safety and efficacy of direct oral anticoagulants have not yet been sufficiently addressed. Here, we report two patients in whom chronic DIC was stabilized upon administration of apixaban: an elderly male with aortic dissection presenting with significant mucocutaneous bleeding and a younger female with Klippel-Trénaunay-Weber syndrome presenting with multiple superficial vein thromboses (SVTs). In addition to an improvement in DIC parameters, both patients benefited clinically with resolution of bleeding symptoms and prevention of further SVTs, respectively. Oral apixaban thus showed promising safety and efficacy in the management of DIC caused by vascular abnormalities; still further investigations are needed to support these findings. :Zu den charakteristischen Komplikationen der disseminierten intravasalen Gerinnung (disseminated intravascular coagulation, DIC) gehören sowohl ein erhöhtes Blutungsrisiko (bedingt durch eine Verbrauchskoagulopathie mit sekundärer Hyperfibrinolyse) als auch das Multiorganversagen (als Folge von Mikrothrombosen in den Organendstrombahnen). Mit Hilfe einer antikoagulatorischen Therapie soll die durch die DIC induzierte exzessive Thrombingenerierung mit konsekutiver Fibrinablagerung reduziert werden. Während sich der Einsatz von Heparinen zur symptomatischen Behandlung der DIC bereits bewährt hat, konnten die Sicherheit und Wirksamkeit von direkten oralen Antikoagulantien bislang noch nicht ausreichend belegt werden. Wir berichten über zwei Patienten, bei denen eine chronische DIC jeweils durch die Einnahme von Apixaban stabilisiert werden konnte: ein älterer männlicher Patient mit Aortendissektion und ausgeprägten mukokutanen Einblutungen sowie eine jüngere Patientin mit Klippel-Trénaunay-Weber-Syndrom, welche mit multiplen oberflächlichen Venenthrombosen vorstellig wurde. Neben einer Verbesserung der laboranalytischen DIC-Parameter kam es bei beiden Patienten unter Einnahme von Apixaban zu einem deutlichen Rückgang der klinischen Beschwerdesymptomatik: Blutungssymptome sistierten und ein Auftreten weiterer oberflächlicher Venenthrombosen konnte verhindert werden. In beiden Fällen stellte die Einnahme von Apixaban somit eine wirksame und sichere Therapie der vaskulär bedingten DIC dar. Weitere Untersuchungen sind jedoch erforderlich, um diese Beobachtungen zu bestätigen.
journal_name
Hamostaseologiejournal_title
Hamostaseologieauthors
Janjetovic S,Holstein K,Dicke C,Bokemeyer C,Langer Fdoi
10.1055/s-0038-1675386subject
Has Abstractpub_date
2019-08-01 00:00:00pages
294-297issue
3eissn
0720-9355issn
2567-5761journal_volume
39pub_type
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