Oral tranexamic acid combined with low molecular weight heparin only during dialysis sessions successfully controlled chronic disseminated intravascular coagulation associated with aortic aneurysm and aortic dissection in a dialysis patient: a case report with literature review

Disseminated intravascular coagulation (DIC) is a relatively rare but important cause of bleeding diathesis in patients on maintenance dialysis. When the control of underlying disorders causing DIC is not achieved and anticoagulant therapy could not ameliorate the symptoms, other therapeutic options might be considered. While the use of antifibrinolytic agents, such as tranexamic acid, is generally not recommended in patients with DIC, the combined use of these agents with anticoagulants has produced good results in some cases with enhanced fibrinolytic-type DIC. Although the dose of tranexamic acid should be adjusted for patients with renal impairment to avoid neurotoxic complications, there are no widely accepted recommendations for dosage adjustment in dialysis patients. Therefore, the optimal indication and dosage of tranexamic acid in dialysis patients with hyper fibrinolytic type DIC remain unestablished. We herein report a 94-year-old male patient on maintenance hemodialysis with hyperfibrinolytic DIC induced by chronic aortic aneurysm and aortic dissection. He suffered from hemorrhagic diathesis and was successfully treated with oral administration of 750 mg tranexamic acid per day combined with intravenous infusion of low molecular weight heparin (LMWH) every dialysis session. There were no apparent adverse events. Unintended dose reduction of tranexamic acid resulted in exacerbation of DIC along with alarming recurrence of blood flow in the previously thrombosed aortic false lumen, which was ameliorated soon after surely performing medication. Combined use of oral tranexamic acid and minimum anticoagulant only during dialysis sessions successfully controlled aneurysm-induced DIC in a dialysis patient. Although the exact dosage and indication require further investigation, the treatment may be worth considering, even in dialysis patients, when other treatment options have failed to obtain good results.