From the Guidelines
Management of Disseminated Intravascular Coagulation (DIC) involves a multifaceted approach. The primary goal is to address the underlying cause of DIC, while also providing supportive care to manage bleeding and thrombotic complications.
Supportive Care
- In patients with DIC and active bleeding, platelet transfusion is suggested to maintain a platelet count above 50 x 10^9/L 1.
- Fresh frozen plasma (15-30 mL/kg) may be transfused with careful clinical monitoring to decide on dose adjustments, and prothrombin complex concentrates can be used in cases of concerns over volume overload 1.
- In actively bleeding cases with persistently low fibrinogen values (below 1.5 g/L), transfusion of cryoprecipitate or fibrinogen concentrate is suggested 1.
Inhibition of Excess Thrombin
- Heparin, either unfractionated (UFH) or low-molecular-weight (LMWH), can be used to inhibit excess thrombin generation, but its use should be limited in highly prothrombotic forms of DIC, especially those associated with solid cancers 1.
- LMWH is preferred over UFH in most cases, except in those with a high risk of bleeding and renal failure, where UFH is chosen due to its easier reversibility 1.
Monitoring and Dose Adjustments
- Close monitoring of platelet count, fibrinogen levels, and clotting screens is essential to guide transfusion and anticoagulation therapy 1.
- Dose adjustments should be made based on clinical response and laboratory results, taking into account the risk of bleeding and thrombosis 1.
From the Research
Management of Disseminated Intravascular Coagulation (DIC)
The management of DIC involves several key strategies, including:
- Treatment of the underlying condition triggering the coagulopathy, as emphasized by 2, 3, 4
- Supportive care to minimize the risk of bleeding, such as transfusion of blood products 2, 3
- Platelet transfusion to maintain a platelet count above 50×10⁹/l in cases of bleeding, or above 20-30×10⁹/l in cases without bleeding 2
- Thromboprophylaxis with low-molecular-weight heparin until bleeding ensues or platelet count drops below 30×10⁹/l 2
- Individualized management based on the type of underlying disease, presence of bleeding or thrombotic complications, and laboratory test results 2, 5, 6
Treatment Strategies
Different treatment strategies may be employed, including:
- Elimination of tissue factor-mediated thrombin generation 6
- Restitution of normal anticoagulant function 6
- Use of anticoagulation therapy, such as heparin 5, 4
- Supportive measures, such as transfusion of fresh frozen plasma and platelets 2, 3
Specific Considerations
In certain cases, such as acute leukemia, the management of DIC may require specific considerations, including: