The Korean Journal of Medicine

The Korean Association of Internal Medicine (대한내과학회)
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Protease Inhibitor Treatment of Disseminated Intravascular Coagulation Associated with Aortic Dissection

대동맥박리에 의한 파종성혈관내응고의 단백질분해 효소억제제 치료

  • Ko, Sung-Min (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Nam-Jun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chung-Hun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Jin-Hyun (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Eun-Young (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Kyung-Min (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Duk-Kyung (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 고성민 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 김남준 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 김충훈 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 조진현 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 이은영 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 허경민 (성균관대학교 의과대학 삼성서울병원 내과) ;
  • 김덕경 (성균관대학교 의과대학 삼성서울병원 내과)
  • Published : 2012.03.01
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Abstract

Disseminated intravascular coagulation (DIC) is a rare complication of aortic dissection. We report an unusual case of a 64-year-old woman with DIC associated with chronic aortic dissection who developed catastrophic intracranial hemorrhage. Computed tomography (CT) revealed partially thrombosed false lumen in the chronic dissected aneurysm of the thoracoabdominal aorta, which remained after surgery for acute type A aortic dissection. The laboratory profile showed features of DIC, including thrombocytopenia, hypofibrinogenemia, and increased D-dimer levels. Bleeding diathesis, including ecchymosis and coagulopathy, showed improvement following treatment with protease inhibitors (nafamostat and camostat).

본 증례는 A형 대동맥박리로 수술한 환자에서 남아 있던 흉복부대동맥의 B형 박리성 대동맥류의 거짓내강 내 과도한 혈전형성에 의한 국소적인 응고장애로 인하여 전신적으로 DIC가 발생하였고, DIC의 치료를 위해 저분자량헤파린 사용 중 두개내출혈 발생하여 단백분해효소억제제 치료 후 DIC가 호전된 예이다. 단백분해효소억제제는 대동맥박리 후 발생하는 DIC 치료에 기존의 치료에 반응하지 않거나, 두개 내출혈과 같이 출혈을 동반한 합병증이 있어 항응고제의 사용이 불가한 경우 DIC 치료로 고려할 수 있다.

Keywords

References

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