What is the treatment for Disseminated Intravascular Coagulation (DIC)?

From the Guidelines

Disseminated intravascular coagulation (DIC) treatment should prioritize addressing the underlying cause and providing supportive care, with a focus on treating the triggering condition and using blood component therapy as needed, as recommended by the most recent guidance from the SSC of the ISTH 1. The treatment approach for DIC involves several key components, including:

• Treating the underlying cause, such as infections, trauma, or malignancies, with appropriate therapies like antibiotics, surgery, or chemotherapy.
• Providing supportive care, including blood component therapy, to manage the consequences of DIC, such as bleeding or thrombosis.
• Using platelet transfusions to maintain a platelet count above 50,000/μL in patients with active bleeding, as suggested by the guidance statement from the SSC of the ISTH 1.
• Administering fresh frozen plasma (15–30 mL/kg) with careful clinical monitoring to decide on dose adjustments, and considering the use of prothrombin complex concentrates in cases of concerns over volume overload, as recommended by the guidance statement from the SSC of the ISTH 1.
• Transfusing cryoprecipitate or fibrinogen concentrate in actively bleeding cases with persistently low fibrinogen values (below 1.5 g/L) despite supportive measures, as suggested by the guidance statement from the SSC of the ISTH 1.
• Considering the use of heparin therapy in cases with predominant thrombosis rather than bleeding, typically using low-dose unfractionated heparin (500-750 units/hour), as discussed in the management of cancer-associated DIC guidance from the SSC of the ISTH 1.
• Continuously monitoring coagulation parameters, including platelet count, PT/INR, PTT, fibrinogen, and D-dimer, to guide therapy and adjust treatment as needed, as recommended by the guidance statement from the SSC of the ISTH 1.
• Providing organ support, including mechanical ventilation, vasopressors, or renal replacement therapy, as necessary in critically ill patients, to manage the complications of DIC. It is essential to note that the treatment of DIC requires a comprehensive approach, taking into account the underlying cause, the severity of the condition, and the patient's overall clinical status, as emphasized by the guidance statement from the SSC of the ISTH 1.

From the FDA Drug Label

Heparin Sodium Injection is indicated for: • Prophylaxis and treatment of venous thrombosis and pulmonary embolism; • Prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease; • Atrial fibrillation with embolization; • Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation); • Prevention of clotting in arterial and cardiac surgery; • Prophylaxis and treatment of peripheral arterial embolism. • Anticoagulant use in blood transfusions, extracorporeal circulation, and dialysis procedures.

The treatment for DIC (Disseminated Intravascular Coagulation) with heparin is indicated as treatment of acute and chronic consumptive coagulopathies. The recommended dosage for this condition is not explicitly stated, but the general dosage for therapeutic anticoagulant effect with full-dose heparin can be found in the label 2.

From the Research

Treatment of Disseminated Intravascular Coagulation (DIC)

The treatment of DIC is primarily focused on addressing the underlying cause of the condition, as well as managing its clinical manifestations. The following are key aspects of DIC treatment:

• Treatment of the underlying condition: This is the cornerstone of DIC management, as it helps to eliminate the trigger mechanism and prevent further activation of coagulation 3, 4, 5, 6, 7.
• Supportive care: This includes the use of blood products, such as platelets and fresh frozen plasma, to correct coagulopathy and manage bleeding 3, 4, 7.
• Anticoagulation therapy: This may be used in certain cases of DIC, such as those with thrombotic complications, to prevent further clotting 3, 4, 5.
• Use of antifibrinolytic agents: These may be used in cases of DIC with primary hyperfibrinolytic state and severe bleeding 3.
• Use of recombinant human activated protein C: This may be used in cases of severe sepsis and DIC, but its use is limited due to the risk of bleeding 3, 5.

Blood Product Transfusion

The transfusion of blood products, such as platelets and fresh frozen plasma, is an important aspect of DIC management. The following are key considerations:

• Platelet transfusion: This should be considered in patients with DIC and bleeding, or those at high risk of bleeding, with a platelet count of <50 x 10^9/L 3, 4.
• Fresh frozen plasma transfusion: This may be useful in patients with DIC and bleeding, or those at high risk of bleeding, with prolonged prothrombin time and activated partial thromboplastin time 3.

Anticoagulation Therapy

Anticoagulation therapy may be used in certain cases of DIC, such as those with thrombotic complications. The following are key considerations:

• Heparin: This may be used in patients with DIC and thrombotic complications, such as arterial or venous thromboembolism 3, 4, 5.
• Low-molecular-weight heparin: This may be used for thromboprophylaxis in patients with DIC, until bleeding ensues or platelet count drops below 30 x 10^9/L 4.