Coagulation Disorders in Aortic Aneurysm Management

Aortic aneurysms pose a unique haemostatic challenge, frequently giving rise to a consumptive coagulopathy characterised by simultaneous activation of clotting and fibrinolytic pathways. The presence of intraluminal thrombus and turbulent flow within the dilated aortic segment promotes ongoing thrombin generation, platelet consumption and secondary fibrinolysis. Patients may present with laboratory evidence of low platelet count, reduced fibrinogen levels and elevated D-dimer, yet classical coagulation times such as prothrombin time and activated partial thromboplastin time can be misleading. Effective management requires a dual focus on definitive aneurysm repair—whether open or endovascular—and meticulous perioperative modulation of coagulation. A spectrum of pharmacological agents, from unfractionated heparin to direct oral anticoagulants and serine protease inhibitors, has been deployed to restore haemostatic balance. Multidisciplinary assessment and personalised combination therapy are essential to mitigate both bleeding and thrombotic risks in this growing patient population.

Research from Nature Portfolio

No recent Nature Portfolio content available.

Coagulation Disorders in Aortic Aneurysm Management publication trend

The graph below shows the total number of articles in coagulation disorders in aortic aneurysm management across all publications each year (not limited to Nature Index journals).

Technical terms

Disseminated intravascular coagulation (DIC): A systemic disorder in which widespread coagulation activation leads to both thrombosis and bleeding due to consumption of clotting factors and platelets.

Fibrinolysis: The enzymatic process that dissolves blood clots, primarily through plasmin-mediated degradation of fibrin.

Direct oral anticoagulant (DOAC): A class of anticoagulant drugs that inhibit specific activated coagulation factors, allowing for oral administration and predictable pharmacokinetics.

Recombinant human soluble thrombomodulin (rhTM): A bioengineered molecule that binds thrombin and promotes activation of protein C, thereby exerting anticoagulant and anti‐inflammatory effects.

Enhanced‐fibrinolytic‐type DIC: A variant of DIC in which fibrinolysis predominates, resulting in pronounced bleeding risk alongside low clotting factor levels.

References

1. Therapeutic Strategies for Disseminated Intravascular Coagulation Associated with Aortic Aneurysm. International Journal of Molecular Sciences (2022).
2. The two therapeutic strategies of surgical intervention and medical management in a patient with enhanced-fibrinolytic type of disseminated intravascular coagulation after aortic replacement for Stanford type A aortic dissection with chronic heart and renal failure. BMC Cardiovascular Disorders (2024).
3. The usefulness of tranexamic acid for bleeding symptoms of chronic consumptive coagulopathy complicated by aortic disease: a single-institute, retrospective study of 14 patients. Thrombosis Journal (2023).
4. A case of abdominal aortic aneurysm presenting as symptomatic disseminated intravascular coagulation treated with endovascular aneurysm repair and postoperative administration of Nafamostat mesylate. Surgical Case Reports (2024).