From the Guidelines
Disseminated Intravascular Coagulation (DIC) should be diagnosed and treated based on a combination of clinical assessment and laboratory findings, with a focus on addressing the underlying cause and managing coagulation abnormalities, as recommended by the International Society on Thrombosis and Hemostasis 1.
Diagnostic Criteria
The diagnosis of DIC involves the following criteria:
- Thrombocytopenia (platelet count <100,000/μL)
- Elevated fibrin degradation products (D-dimer >1 μg/mL)
- Prolonged prothrombin time and activated partial thromboplastin time (PT/aPTT)
- Decreased fibrinogen levels (<100 mg/dL) The International Society on Thrombosis and Hemostasis scoring system, which incorporates these parameters, can help confirm the diagnosis, with a score ≥5 indicating overt DIC.
Treatment Options
Treatment primarily involves addressing the underlying condition causing DIC, such as sepsis, trauma, or malignancy. Supportive care includes:
- Blood component therapy with platelets (for counts <50,000/μL with bleeding) 1
- Fresh frozen plasma (15–30 mL kg-1) for coagulation factor replacement, with careful clinical monitoring to decide on dose adjustments 1
- Cryoprecipitate (two pools or fibrinogen concentrate) when fibrinogen is <1.5 g L-1 1 Anticoagulation with heparin (typically unfractionated heparin at 10-15 units/kg/hr without a loading dose) may be considered in cases with predominant thrombosis, particularly in purpura fulminans or acral ischemia 1. Antifibrinolytic agents like tranexamic acid are generally contraindicated in DIC except in specific cases of hyperfibrinolysis 1. Continuous monitoring of coagulation parameters is essential to guide therapy, as DIC represents a dynamic imbalance between clotting and bleeding that requires individualized management based on the clinical presentation and laboratory trends.
From the FDA Drug Label
• Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation) The diagnosis of Disseminated Intravascular Coagulation (DIC) is not directly described in the provided drug labels. However, the treatment options for DIC are mentioned as heparin can be used for the treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation) 2 2. Key points about the treatment of DIC with heparin include:
- Therapeutic Anticoagulant Effect with Full-Dose Heparin
- Dosage: The recommended dosage for heparin varies depending on the patient's condition and the route of administration.
- Administration: Heparin can be administered intravenously or subcutaneously. It is essential to note that the provided drug labels do not explicitly describe the diagnostic criteria for DIC.
From the Research
Diagnostic Criteria for Disseminated Intravascular Coagulation (DIC)
- The diagnosis of DIC should encompass both clinical and laboratory information, utilizing the International Society for Thrombosis and Haemostasis (ISTH) DIC scoring system for objective measurement 3.
- The ISTH DIC scoring system correlates with key clinical observations and outcomes, and it is essential to repeat tests to monitor the dynamically changing scenario based on laboratory results and clinical observations 3.
- An updated definition of DIC has been proposed, characterizing it as an acquired, life-threatening intravascular disorder with systemic coagulation activation, dysregulated fibrinolysis, and endothelial injury, resulting in microthrombosis 4.
Treatment Options for DIC
- The cornerstone of DIC treatment is addressing the underlying condition 3, 5, 6.
- Transfusion of platelets or plasma (components) in patients with DIC should not be based solely on laboratory results and should generally be reserved for patients who present with bleeding 3.
- In patients with DIC and bleeding or at high risk of bleeding, transfusion of platelets should be considered if the platelet count is <50 x 10(9)/l 3.
- Administration of fresh frozen plasma (FFP) may be useful in bleeding patients with DIC and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) 3.
- Severe hypofibrinogenemia (<1 g/l) that persists despite FFP replacement may be treated with fibrinogen concentrate or cryoprecipitate 3.
- In cases of DIC where thrombosis predominates, therapeutic doses of heparin should be considered, and prophylaxis for venous thromboembolism with prophylactic doses of heparin or low molecular weight heparin is recommended in critically ill, non-bleeding patients with DIC 3, 7, 6.
- Recombinant human activated protein C may be considered for patients with severe sepsis and DIC, but its use is limited due to the increased risk of bleeding 3, 5.
- Antithrombin concentrate and other anticoagulants have shown promising results in clinical studies, but their efficacy and safety need further assessment 5, 6.