Analysis of Coagulopathy in Patients with Dissecting Aortic Aneurysm

When deciding on the method of treatment for patients with dissecting aortic aneurysm (DA), the following factors should be taken into consideration: the duration of disease, the diameter of the aneurysm, and whether the pseudolumen is thrombosed. Coagulation and fiblolytic activity were investigated in the acute phase (1-14 days from the onset), subacute phase (15-56 days), and chronic phase (>57 days) of DA, and the aneurysms were classified as thrombosed type (type T) or open communicated type (type O). Eighty-six patients (56 men and 30 women) with DA were studied. Twenty-three patients had DeBakey type I aneurysms, while 4 had type II, 7 had type Ilia, and 52 had type Illb. Thirty-five patients had type T disease and 51 had type O. We measured thrombin-antithrombin III complex (TAT), prothrombin fragment 1+2 (F_), tissue plasminogen activator (t-PA), plasminogen activator inhibitor activity (PAIact), D-dimer, β-thromboglobulin (β-TG), and platelet factor 4 (PF4) levels. All patients with DA showed secondary hypercoagulability and hyperfibrinolysis in the acute phase, so they were recognized to be in a pre-DIC state. Type T patients showed hypercoagulability and the onset of thrombus formation in the dilated pseudolumen was suggested to occur in early acute phase due to elevated TAT and β-TG levels. Type O patients showed increased secondary fibrinolysis, because D-dimer levels were higher than in type T patients during each phase. The maximum aneurysm diameter and changes of coagulation parameters were correlated positively in type T patients during the acute and chronic phases, and in type O patients during the acute phase, so these patients were recognized to be in the pre-DIC state. No significant changes were seen in coagulation parameters between the preoperative and postoperative periods in both types of DA, probably due to the effect of graft inplantation and residual dissection of the aorta. This study suggested that mesurement of coagulation parameters may be useful in distinguishing type T and type O aneurysm, and may help to decide on the treatment of DA