From the Guidelines
For a patient suspected of having Disseminated Intravascular Coagulopathy (DIC), immediate laboratory investigations should include complete blood count, coagulation studies (PT, PTT, fibrinogen, D-dimer), peripheral blood smear, and organ function tests. Management begins with treating the underlying cause while providing supportive care. The most recent and highest quality study 1 suggests that the sepsis-induced coagulopathy (SIC) scoring system can be useful in detecting the compensated phase of DIC in sepsis, which can lead to overt DIC with disease progression. Some key points to consider in the management of DIC include:
- Transfusion therapy should be initiated for patients with active bleeding or those requiring invasive procedures, including platelets (if <50,000/μL), fresh frozen plasma (10-15 mL/kg) for prolonged PT/PTT, and cryoprecipitate (10 units) if fibrinogen is <100 mg/dL, as suggested by 1.
- Packed red blood cells should be given for significant anemia.
- Heparin therapy (500-750 units/hour) may be considered in non-bleeding patients with predominant thrombosis, particularly in purpura fulminans or acral ischemia, as mentioned in the example answer.
- Antifibrinolytic agents like tranexamic acid should be avoided in most DIC cases as they may increase thrombotic risk.
- Continuous monitoring of coagulation parameters every 4-6 hours is essential to guide ongoing therapy, as emphasized in the example answer. The rationale for this approach is that DIC involves both excessive clotting (consuming clotting factors) and bleeding, so laboratory confirmation helps distinguish it from other coagulopathies while treatment addresses both the underlying trigger and the coagulation abnormalities to prevent organ damage and death, as explained in 1 and 1.
From the FDA Drug Label
HEPARIN SODIUM INJECTION, for intravenous or subcutaneous use Initial U. S INJECTION is an anticoagulant indicated for (1) • 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)
Monitoring: Blood coagulation tests guide therapy for full-dose heparin. Periodically monitor platelet count, hematocrit, and occult blood in stool in all patients receiving heparin (5.5. 6)
The immediate laboratory investigations for a patient suspected of having Disseminated Intravascular Coagulopathy (DIC) include:
- Blood coagulation tests
- Platelet count
- Hematocrit
- Occult blood in stool
Management involves the use of heparin as an anticoagulant for the treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation) 2.
From the Research
Laboratory Investigations for Disseminated Intravascular Coagulopathy (DIC)
The diagnosis of DIC should encompass both clinical and laboratory information. The following laboratory investigations are used to diagnose DIC:
- Prothrombin time (PT) 3, 4, 5
- Partial thromboplastin time (PTT) 3, 4, 5
- Fibrinogen/fibrin degradation products (FDP) 3, 4, 5
- D-dimer 3, 4, 5
- Platelet count 3, 4, 5
- Fibrinogen 3, 4
- Antithrombin 4, 6, 5
- Thrombin-antithrombin complex (TAT) 5
- Plasmin-α2 plasmin inhibitor (PIC) 5
- α2 plasmin inhibitor (α2PI) 5
Management of DIC
The cornerstone of the treatment of DIC is treatment of the underlying condition 3, 6, 7, 5. The following management strategies are used:
- Transfusion of platelets or plasma (components) in patients with DIC should not primarily be based on laboratory results and should in general 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
- In bleeding patients with DIC and prolonged PT and PTT, administration of fresh frozen plasma (FFP) may be useful 3
- Severe hypofibrinogenaemia (<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 3
- 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
- Recombinant human activated protein C may be used in patients with severe sepsis and DIC, but not in patients at high risk of bleeding 3, 6