Successful combined use of tranexamic acid and unfractionated heparin for life-threatening bleeding associated with intravascular coagulation in a patient with chronic myelogenous leukemia in blast crisis

International Journal of Hematology
Mihoko KosekiKosei Matsue

Abstract

The current therapeutic strategy for disseminated intravascular coagulation (DIC) is limited to control of the underlying disease, and methods for the effective management of DIC have not been established. We report the successful use of tranexamic acid (TA) combined with unfractionated heparin in a patient with life-threatening bleeding from the sigmoid colon caused by DIC. A 35-year-old man who had undergone allogeneic bone marrow transplantation for chronic myelogenous leukemia was referred for relapse of his leukemia. The patient was first treated with imatinib at 600 mg/day. Although the disappearance of leukemic cells and a decrease in the BCR/ABL fusion gene were observed, he developed massive bleeding from the sigmoid colon after defecation. A laboratory diagnosis of DIC with prominent fibrinolysis was based on elevated levels of both plasmin-alpha2-plasmin inhibitor complex and thrombin-antithrombin III complex. Despite vigorous supportive therapy, including multiple transfusions and aggressive fluid resuscitation, the patient developed hypovolemic shock due to the uncontrollable bleeding. TA combined with unfractionated heparin was instituted to inhibit excessive fibrinolysis. A prompt response was observed soon after...Continue Reading

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Citations

Jun 23, 2019·Pediatrics International : Official Journal of the Japan Pediatric Society·Takashi IshiharaMidori Shima
Oct 7, 2016·Thrombosis Journal·Hidesaku AsakuraUNKNOWN DIC subcommittee of the Japanese Society on Thrombosis and Hemostasis
Jun 25, 2015·The Cochrane Database of Systematic Reviews·Arturo J Martí-CarvajalIvan Solà
Jan 3, 2021·International Journal of Hematology·Toshiaki IbaJerrold H Levy

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