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

Treatment of Disseminated Intravascular Coagulation (DIC)

The cornerstone of DIC treatment is addressing the underlying cause while providing supportive care with blood product replacement for bleeding patients and heparin for thrombotic manifestations. 1, 2

Diagnosis and Assessment

• Diagnose DIC using the International Society on Thrombosis and Haemostasis (ISTH) scoring system based on:

  • Platelet count (normal: 150-450 × 10^9/L; DIC: <50 × 10^9/L)
  • Prothrombin time/INR (normal: 11-14 seconds/0.9-1.1; DIC: >14 seconds/>1.1)
  • Fibrinogen (normal: 2-4 g/L; DIC: <1.5 g/L)
  • D-dimer (normal: <0.5 mg/L; DIC: >0.5 mg/L) 1

• Serial laboratory monitoring is essential as DIC is a dynamic process 1, 2

Treatment Algorithm

Step 1: Treat the Underlying Cause

• Identify and aggressively treat the underlying condition (sepsis, trauma, malignancy, obstetric complications) 1, 3

Step 2: Supportive Management Based on Clinical Presentation

For Bleeding-Predominant DIC:

1. Blood Product Replacement (only for active bleeding or high bleeding risk):

   • Platelet transfusion if count <50 × 10^9/L in actively bleeding patients 1, 2
   • Fresh Frozen Plasma (FFP) 15-30 mL/kg for prolonged PT/PTT 1
   • Fibrinogen concentrate or cryoprecipitate if fibrinogen remains <1 g/L despite FFP 1, 2

2. Avoid prophylactic transfusions in non-bleeding patients as this may worsen thrombosis 1

For Thrombosis-Predominant DIC:

1. Heparin therapy is indicated for:

   • Arterial or venous thromboembolism
   • Severe purpura fulminans with acral ischemia
   • Vascular skin infarction 2

2. Heparin administration:

   • Heparin is FDA-approved for treatment of acute and chronic consumptive coagulopathies (DIC) 4
   • Consider continuous infusion unfractionated heparin (UFH) at weight-adjusted doses (e.g., 10 μ/kg/h) 2
   • Monitor closely for bleeding complications 2

Step 3: Additional Therapies Based on Specific Scenarios

• For critically ill, non-bleeding DIC patients: Consider prophylactic doses of heparin or LMWH for VTE prevention 2

• For severe sepsis with DIC: Consider recombinant human activated protein C (24 μg/kg/h for 4 days) in patients without high bleeding risk 2

• For primary hyperfibrinolytic DIC with severe bleeding: Consider tranexamic acid (1 g every 8 hours) 2

Important Cautions and Pitfalls

• Do not use antifibrinolytic agents in general DIC cases (only in primary hyperfibrinolytic states) 2

• Do not delay treatment of the underlying disease 1

• Avoid misinterpreting normal coagulation screens, as normal PT/aPTT does not exclude DIC 1

• Recognize the short lifespan of transfused products in active DIC, necessitating repeated assessments 1

• Do not use recombinant Factor VIIa due to thrombotic risks and lack of evidence 1

• Be aware that DIC can transition from a prothrombotic phase to hemostatic insufficiency as the condition evolves 3

Special Considerations for Procedures

• For central line placement in DIC patients:
  • Choose compressible sites
  • Correct coagulopathy before the procedure
  • Prefer tunneled central venous catheters for long-term access
  • Use single-lumen catheters when possible 1