Hamostaseologie 2019; 39(03): 294-297
DOI: 10.1055/s-0038-1675386
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Apixaban for the Treatment of Chronic Disseminated Intravascular Coagulation: A Report of Two Cases

Snjezana Janjetovic
1   Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum – University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
,
Katharina Holstein
1   Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum – University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
,
Christina Dicke
1   Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum – University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
,
Carsten Bokemeyer
1   Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum – University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
,
Florian Langer
1   Department of Oncology and Hematology, BMT with Section of Pneumology, Hubertus Wald Tumorzentrum – University Cancer Center Hamburg, University Medical Center Eppendorf, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

27 May 2018

05 September 2018

Publication Date:
19 November 2018 (online)

Abstract

Characteristic features of disseminated intravascular coagulation (DIC) are the opposing risks of bleeding (due to consumptive coagulopathy and hyperfibrinolysis) and organ failure (due to widespread microvascular thromboses). The purpose of anticoagulation in DIC is to attenuate excessive thrombin generation and fibrin deposition. While heparins have been shown to be beneficial in this context, the safety and efficacy of direct oral anticoagulants have not yet been sufficiently addressed. Here, we report two patients in whom chronic DIC was stabilized upon administration of apixaban: an elderly male with aortic dissection presenting with significant mucocutaneous bleeding and a younger female with Klippel–Trénaunay–Weber syndrome presenting with multiple superficial vein thromboses (SVTs). In addition to an improvement in DIC parameters, both patients benefited clinically with resolution of bleeding symptoms and prevention of further SVTs, respectively. Oral apixaban thus showed promising safety and efficacy in the management of DIC caused by vascular abnormalities; still further investigations are needed to support these findings.

Zusammenfassung

Zu den charakteristischen Komplikationen der disseminierten intravasalen Gerinnung (disseminated intravascular coagulation, DIC) gehören sowohl ein erhöhtes Blutungsrisiko (bedingt durch eine Verbrauchskoagulopathie mit sekundärer Hyperfibrinolyse) als auch das Multiorganversagen (als Folge von Mikrothrombosen in den Organendstrombahnen). Mit Hilfe einer antikoagulatorischen Therapie soll die durch die DIC induzierte exzessive Thrombingenerierung mit konsekutiver Fibrinablagerung reduziert werden. Während sich der Einsatz von Heparinen zur symptomatischen Behandlung der DIC bereits bewährt hat, konnten die Sicherheit und Wirksamkeit von direkten oralen Antikoagulantien bislang noch nicht ausreichend belegt werden. Wir berichten über zwei Patienten, bei denen eine chronische DIC jeweils durch die Einnahme von Apixaban stabilisiert werden konnte: ein älterer männlicher Patient mit Aortendissektion und ausgeprägten mukokutanen Einblutungen sowie eine jüngere Patientin mit Klippel-Trénaunay-Weber-Syndrom, welche mit multiplen oberflächlichen Venenthrombosen vorstellig wurde. Neben einer Verbesserung der laboranalytischen DIC-Parameter kam es bei beiden Patienten unter Einnahme von Apixaban zu einem deutlichen Rückgang der klinischen Beschwerdesymptomatik: Blutungssymptome sistierten und ein Auftreten weiterer oberflächlicher Venenthrombosen konnte verhindert werden. In beiden Fällen stellte die Einnahme von Apixaban somit eine wirksame und sichere Therapie der vaskulär bedingten DIC dar. Weitere Untersuchungen sind jedoch erforderlich, um diese Beobachtungen zu bestätigen.

Authors' Contribution

S.J. acquired and analysed data and drafted the first version of the manuscript. K.H., C.D. and C.B. interpreted data and critically revised the manuscript. F.L. conceived the study, analysed data and co-wrote the manuscript.


 
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