Aortic aneurysms are sometimes accompanied with disseminated intravascular coagulation (DIC). The definitive treatment of DIC is removal of underlying disease; surgical repair for the aortic aneurysms. Heparin, anticoagulant and other antifibrinolytic agents have been administered preoperatively to alleviate DIC whose bleeding tendency could cause high mortality and morbidity; however, their effectiveness was indeterminate. An 84-year-old man was presented with abdominal aortic aneurysm accompanied by DIC and underwent aneurysmectomy. After having confirmed that combined use of heparin and gabexate mesilate was ineffective, we used recombinant human soluble thrombomodulin (rhsTM), which has been reported to be more effective and safer than the heparin, for a week preoperatively, and demonstrated dramatic improvement of DIC. RhsTM should be a novel powerful therapeutic option for aneurysm-induced DIC.