第5巻 2009年6月　第3号

■症例から学ぶ

偽腔開存型急性大動脈解離に伴う慢性消費性凝固障害に対し抗線溶療法が著効した1例
坪井　一平¹, 平山　悦之¹, 村田　広茂¹, 高野　仁司¹, 高木　元¹, 水野　杏一¹, 時田　祐吉², 田中　啓治², 汲田　伸一郎^3
1日本医科大学大学院医学研究科器官機能病態内科学
²日本医科大学付属病院集中治療室
³日本医科大学大学院医学研究科臨床放射線医学

A Case of Acute Aortic Dissection with Chronic Consumption Cogulopathy Successfully Treated with Antifibrinolytic Therapy
Ippei Tsuboi¹, Yoshiyuki Hirayama¹, Hirosige Murata¹, Hitoshi Takano¹, Gen Takagi¹, Kyoichi Mizuno¹, Yukichi Tokita², Keiji Tanaka² and Shinichiro Kumita^3
1)Division of Cardiology, Hepatology, Geriatrics, and Integrated Medicine, Department of Internal Medicine, Graduate School of Medicine, Nippon Medical School
²⁾Coronary Care Unit, Nippon Medical School Hospital
³⁾Department of Clinical Radiology, Graduate School of Medicine, Nippon Medical School

An 80-year old man with a history of abdominal aortic aneurysm was emergently admitted to our hospital with suspected ileus. The previous day he had had back pain and abdominal pain. A chest X-ray film showed widening of the aortic shadow. A computed tomography scan with contrast enhancement revealed aortic dissection (Stanford B, De Bakey IIIb). We started conservative hypotensive therapy with nicardipine, without operation or stent grafting, because of the involvement of the major branches of the aortic arch. However, the false lumen was not thrombosed during conservative therapy. Three months later a computed tomography scan with contrast enhancement revealed aortic dissection with a false lumen from the left subclavian artery through the level of the diaphragm. Petechiae were noted over the skin of the thorax and abdomen. Coagulation studies revealed a low platelet count and increased levels of fibrin degradation products and thrombin-antithrombin, indicating disseminated intravascular coagulation due to chronic consumption coagulopathy associated with aortic dissection. Because the bleeding tendency persisted in spite of the initial hypotensive therapy and blood transfusion, we began antifibrinolytic therapy with tranexamic acid. After the antifibrinolytic therapy, the platelet count and levels of fibrinogen and fibrinogen degradation products improved, and the false lumen of the aortic dissection was thrombosed. We conclude that antifibrinolytic therapy with tranexamic acid is effective for treating disseminated intravascular coagulation and for thrombosing the false lumen of aortic dissection.

日医大医会誌 2009; 5(3), 167-171

Key words
aortic dissection, chronic consumption coagulopathy, tranexiamic acid

Correspondence to
Ippei Tsuboi, Division of Cardiology, Hepatology, Geriatrics and Integrated Medicine, Department of Internal Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan
E-mail：s00-051@nms.ac.jp

受付：2009年2月10日　受理：2009年4月28日