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Frontiers of Medicine

ISSN 2095-0217

ISSN 2095-0225(Online)

CN 11-5983/R

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Front. Med.    2017, Vol. 11 Issue (1) : 62-67    https://doi.org/10.1007/s11684-017-0498-7
RESEARCH ARTICLE
Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients
Yun Zhang1,Chen Li1,Min Shen2,Bao Liu3,Xuejun Zeng1(),Ti Shen4
1. Department of General Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
2. Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
3. Department of Vascular Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
4. Department of Internal Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Abstract

Chronic disseminated intravascular coagulation (DIC) is a rare but devastating complication of aortic aneurysm (AA). This study investigated the clinical manifestations, laboratory findings, and treatment of patients with AA-associated chronic DIC (AA-DIC) and explored the mechanisms, duration, and therapeutic response of AA-DIC. We retrospectively reviewed the medical records of 235 AA patients admitted at the Peking Union Medical College Hospital between September 2009 and January 2015. The patients were classified as those with DIC (AA-DIC) and those without DIC (non-DIC). The AA-DIC group showed a significantly higher proportion of female patients and a significantly longer AA disease course than the non-DIC group did. The AA-DIC patients presented mural thrombi, dissecting aneurysms, a family history of AA, and diabetes significantly more frequently than the non-DIC patients did. Furthermore, multiple regression analyses revealed that sex, mural thrombus, aneurysm type, diabetes, and stent surgery are possible independent risk factors for AA-DIC patients. Fifty-two (22.1%) patients presented AA-DIC. Among these patients, 43 had non-typical DIC and 9 had typical DIC; the mortality rate of the latter was 22.2%. The mean age of the patients with typical DIC was significantly higher than of that of patients with non-typical DIC. The non-typical DIC patients also presented abnormal coagulation disorders of varying degrees. Furthermore, heparin or low-molecular-weight heparin improved the clinical symptoms and laboratory parameters in patients with AA and typical DIC. Thus, chronic DIC should be considered in patients with AA.
Keywords aortic aneurysm      disseminated intravascular coagulation      anticoagulation therapy     
Corresponding Author(s): Xuejun Zeng   
Just Accepted Date: 05 January 2017   Online First Date: 23 February 2017    Issue Date: 20 March 2017
 Cite this article:   
Yun Zhang,Chen Li,Min Shen, et al. Aortic aneurysm and chronic disseminated intravascular coagulation: a retrospective study of 235 patients[J]. Front. Med., 2017, 11(1): 62-67.
 URL:  
https://academic.hep.com.cn/fmd/EN/10.1007/s11684-017-0498-7
https://academic.hep.com.cn/fmd/EN/Y2017/V11/I1/62
AA-DIC Non-DIC P
N 52 183
Age (year*) 71±13 60±17 0.651
Sex ratio (M:F) 31:21 146:37 0.003
Length of AA disease course (year*) 5.1±4.2 3.1±2.3 0.047
Tab.1  Baseline demographic data of AA patients with or without chronic DIC
AA-DIC
Total= 52
n (%)		 Non-DIC
Total= 183
n (%)		 P
Aneurysm location
Abdominal AA 37 (71.2) 101 (55.2) 0.119
Thoracic AA 6 (11.5) 32 (17.5)
Combined AA 9 (17.3) 50 (27.3)
Mural thrombus 41 (78.8) 67 (36.6) 0.000
Type of aneurysm
True aneurysm 18 (34.6) 121 (66.1) 0.000
Pseudo-aneurysm 8 (15.4) 41 (22.4)
Dissecting aneurysm 26 (50.0) 21 (11.5)
Tab.2  Clinical characteristics of AA patients with or without DIC
Fig.1  A patient’s computed tomography angiography of abdominal aortic aneurysm.
AA-DIC
Total= 52
n (%)		 Non-DIC
Total= 183
n (%)		 P
Comorbidities
Atherosclerosis 40 (76.9) 123(67.2) 0.180
Hypertension 36 (69.2) 117(63.9) 0.480
Diabetes 29(55.8) 69(37.7) 0.020
Hyperlipidemia 34(65.4) 137 (74.9) 0.175
Risk factors
Smoking habit 37(71.2) 131 (71.6) 0.952
Family history 10(19.2) 15(8.2) 0.023
Laboratory findings
ESR increase 11 (21.2) 30 (16.4) 0.192
CRP increase 21 (40.4) 37 (20.2) 0.467
Treatment
Stent surgery 23 (44.2) 41 (22.4) 0.002
Revascularization surgery 8 (15.4) 12 (6.6) 0.044
Tab.3  Comorbidities, risk factors, laboratory findings, and treatment of AA patients with or without DIC
OR 95% CI P
Sex ratio 1.863 1.017?2.891 0.037
Length of AA disease course 1.978 0.971?2.019 0.912
Aneurysm location 1.557 0.801?3.230 0.517
Mural thrombus 5.952 1.378?11.050 0.004
Type of aneurysm 3.129 1.264?8.743 0.011
Atherosclerosis 2.369 0.674?2.971 0.594
Diabetes 2.544 1.120?7.241 0.021
Hyperlipidemia 0.816 0.763?2.216 0.823
Family history 2.323 0.886?3.081 0.775
ESR increase 2.006 0.614?4.787 0.494
Stent surgery 3.557 1.283?4.128 0.016
Revascularization surgery 2.134 0.912?3.013 0.729
Tab.4  Multiple regression analysis of risk factors for DIC in AA patients
Typical DIC Non-typical DIC P
Patient number. 9 43
Age (year*) 81±11 67±16 0.031
Sex ratio (M:F) 4:5 27:16 0.308
Length of AA disease course (year*) 1.2±1.1 6.7±5.9 0.000
Tab.5  Clinical characteristics of AA patients with typical or non-typical DIC
Fig.2  Overt bleeding diathesis of an AA patient with typical DIC.
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