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

From the Guidelines

The primary treatment for Disseminated Intravascular Coagulation (DIC) should focus on addressing the underlying cause, with supportive care measures including platelet transfusions to maintain a count above 50 x 10^9/L in patients with active bleeding, as suggested by the guidance from the SSC of the ISTH 1.

Key Supportive Measures

• Platelet transfusions are recommended for patients with DIC and active bleeding to maintain the platelet count above 50 x 10^9/L 1.
• Fresh frozen plasma (15–30 mL/kg) should be transfused with careful clinical monitoring to decide on dose adjustments in patients with DIC and active bleeding, with the option to use prothrombin complex concentrates in cases of concerns over volume overload 1.
• In actively bleeding cases with persistently low fibrinogen values (below 1.5 g/L), transfusion of two pools of cryoprecipitate or fibrinogen concentrate is suggested 1.

Underlying Cause Treatment

• Appropriate treatment of the underlying cancer is recommended as the first-line strategy for cancer-related DIC 1.
• Prophylactic anticoagulation is recommended in all patients with cancer-related DIC, except hyperfibrinolytic DIC, in the absence of contraindications, with therapeutic-dose anticoagulation used in those who develop arterial or venous thrombosis 1.

Monitoring and Surveillance

• Regular clinical and laboratory surveillance is essential to assess the improvement or worsening of the patient, detect the development of complications, and ensure the underlying condition is being adequately treated 1.

From the FDA Drug Label

HEPARIN SODIUM INJECTION, for intravenous or subcutaneous use Initial U. S INJECTION is an anticoagulant indicated for ... • Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation)

The treatment for Disseminated Intravascular Coagulation (DIC) is Heparin Sodium Injection. The recommended dosage can be found in the DOSAGE AND ADMINISTRATION section of the label, but it is not explicitly stated for DIC, so the general Therapeutic Anticoagulant Effect with Full-Dose Heparin dosages should be used as a guide, under the supervision of a healthcare professional, and with careful monitoring of blood coagulation tests. 2

From the Research

Treatment Overview

The treatment of Disseminated Intravascular Coagulation (DIC) primarily focuses on addressing the underlying condition that triggered the disorder. Additional therapeutic strategies aim to manage the activation of blood coagulation and the risk of bleeding 3, 4, 5, 6, 7.

Treatment of Underlying Condition

• The cornerstone of DIC treatment is the management of the underlying disease or condition that led to the development of DIC 3, 4, 5, 6, 7.
• This approach is crucial in controlling the progression of DIC and preventing further complications.

Transfusion Therapy

• 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.
• Fresh frozen plasma (FFP) may be useful in bleeding patients with DIC and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) 3.

Anticoagulant Therapy

• In cases of DIC where thrombosis predominates, therapeutic doses of heparin should be considered 3.
• Unfractionated heparin or low-molecular-weight heparin may be used for thromboembolic prophylaxis in patients at high risk who do not have active bleeding 3, 7.

Other Therapeutic Options

• Recombinant human activated protein C may be considered in patients with severe sepsis and DIC, but its use is not recommended in patients at high risk of bleeding 3, 4, 7.
• Antithrombin concentrate is not recommended for the treatment of DIC in the absence of further prospective evidence from randomized controlled trials 3, 4.
• Antifibrinolytic agents, such as tranexamic acid, may be considered in patients with DIC characterized by a primary hyperfibrinolytic state and severe bleeding 3.