From the Guidelines
Disseminated intravascular coagulation (DIC) should be managed with a focus on correcting the underlying cause, and treatment with platelets, FFP, and cryoprecipitate should be given sooner rather than later, in sufficient dosage but avoiding circulatory overload, as recommended by the most recent guidelines 1. The management of DIC is crucial to prevent morbidity, mortality, and to improve the quality of life of patients.
- The diagnosis of DIC should be made based on laboratory evidence, including platelet count, fibrinogen, PT, and APTT, as well as the measurement of fibrinogen degradation products or D-dimers 1.
- The treatment of DIC should be tailored to the individual patient, taking into account the underlying cause and the severity of the condition.
- The use of anticoagulant therapy, such as heparin, may be considered in certain cases of DIC, particularly those with a high risk of thrombosis 1.
- The management of DIC in critically ill patients, such as those with sepsis, requires a multidisciplinary approach and the use of specific diagnostic criteria, such as the ISTH overt-DIC diagnostic criteria 1.
- Recent studies have highlighted the importance of endothelial dysfunction in the pathogenesis of DIC, and the potential role of endothelium-related biomarkers in the diagnosis and management of the condition 1.
- The most recent guidelines recommend a two-step diagnostic approach, assessing first for sepsis-induced coagulopathy (SIC) and if SIC criteria are met, assessing for overt DIC, to facilitate early recognition and intervention 1.
From the Research
Definition and Diagnosis of Disseminated Intravascular Coagulation (DIC)
- DIC is an acquired clinicobiological syndrome characterized by widespread activation of coagulation leading to fibrin deposition in the vasculature, organ dysfunction, consumption of clotting factors and platelets, and life-threatening hemorrhage 2.
- The diagnosis of DIC is based on criteria such as a low platelet count, positive plasma protamine test, and fibrinogen and fibrin degradation product levels viewed in the context of the patient's underlying disease 3.
Treatment and Management of DIC
- The cornerstone of therapy is prompt treatment of the underlying disease and elimination of the trigger mechanism 3, 2, 4.
- Additional treatment must be individualized, and generalizations are difficult to make 3.
- Heparin is indicated in patients with purpura fulminans and venous thromboembolism, but there is little evidence that heparin reverses organ dysfunction associated with DIC 3.
- Anticoagulant therapies, such as heparin, antithrombin, activated protein C, and recombinant human-soluble thrombomodulin, may be used to regulate the progression of coagulopathy in sepsis-induced DIC, but their efficacy is still uncertain 5.
Underlying Conditions and Epidemiology of DIC
- DIC can be provoked by several underlying disorders, including sepsis, cancer, trauma, and pregnancy complicated with eclampsia or other calamities 2.
- Cancer often leads to the activation of coagulation, manifesting as DIC in its most extreme form 6.
- The epidemiology of DIC and its current understanding of its pathophysiology are essential for timely and accurate diagnosis and management 4.