A scoping review of consumptive coagulopathy and disseminated intravascular coagulation in aortic aneurysm and aortic dissection

Background Aortic dissection and aneurysms may be complicated by coagulopathies, among which disseminated intravascular coagulation (DIC) represents a severe life-threatening form, with major prognostic implications. Although DIC has been reported in association with aortic disease, its incidence and risk factors in the era of endovascular repair are poorly described. We summarized the available evidence on the incidence, risk factors, and prognostic implications of DIC in patients with aortic dissection or aneurysm, either in the preoperative setting or after endovascular repair. Methods A structured search of MEDLINE (PubMed) and SCOPUS was conducted using terms for aortic disease and DIC. Of 670 records, 441 unique studies were screened; 44 full texts were assessed, and 15 met the inclusion criteria. Eligible designs included observational or experimental studies and case series of five or more patients reporting hematological parameters or DIC outcomes in aortic aneurysm or dissection before or after endovascular repair. Data extraction was performed independently by two reviewers. Findings are summarized narratively. Results We identified15 studies, including prospective and retrospective cohort, descriptive case series, and one nonrandomized study of intervention, that fulfilled the selection criteria. Preoperatively, DIC was identified in ≤25% of aneurysm cohorts, associated with mural thrombus burden and thoracoabdominal extension, and in 21% of dissections, significantly related to false lumen diameter and length. In acute aortic dissection cohorts with >1000 patients, thrombocytopenia plus elevated D-dimer increased mortality 3.6-fold (hazard ratio, 3.59; 95% confidence interval, 2.00-6.42), and DIC doubled in-hospital mortality. After endovascular repair, transient platelet count reduction and elevated D-dimer were observed in most aortic diseases, with changes more sustained in dissections. Overt postoperative DIC occurred in 3% to 50% of aneurysms depending on aortic coverage length and the presence of endoleak. In thoracoabdominal aneurysm, coverage length of >30 cm has been suggested as an independent predictor of hemorrhagic complications (odds ratio, 1.44; area under the curve, 0.72). Conclusions DIC is a prevalent and consequential complication of aortic aneurysm, dissection, and endovascular repair. Despite heterogeneous diagnostic definitions, its prognostic impact is adverse, strongly linked with increased bleeding risk, transfusion requirements, and mortality. Standardization of diagnostic criteria and systematic assessment of coagulation-fibrinolysis profiles are needed to guide risk stratification and optimize perioperative management in vascular surgery.