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

Treatment of Disseminated Intravascular Coagulation (DIC)

The cornerstone of DIC treatment is addressing the underlying condition while providing supportive care with blood products for bleeding manifestations and considering heparin therapy for thrombotic presentations. 1, 2

Diagnosis and Assessment

• Confirm DIC diagnosis 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

• Perform serial laboratory testing to monitor the dynamic changes in coagulation parameters 1

Treatment Algorithm

Step 1: Treat the Underlying Cause

• Identify and aggressively treat the underlying condition (sepsis, malignancy, trauma, obstetric complications) 1, 2
• This is the most critical intervention for resolving DIC

Step 2: Manage Bleeding Manifestations

For patients with active bleeding or high bleeding risk:

• Platelet transfusion:

  • Indicated when platelet count <50 × 10^9/L with active bleeding or before invasive procedures
  • Not recommended prophylactically in non-bleeding patients 1

• Fresh Frozen Plasma (FFP):

  • Administer 15-30 mL/kg for patients with prolonged PT/PTT and active bleeding
  • Not indicated based on laboratory values alone 1

• Fibrinogen replacement:

  • Consider fibrinogen concentrate or cryoprecipitate when fibrinogen levels remain <1.5 g/L despite FFP administration 1

Step 3: Manage Thrombotic Manifestations

For DIC with predominant thrombosis (arterial/venous thromboembolism, purpura fulminans, vascular skin infarction):

• Heparin therapy:

  • FDA-approved for treatment of acute and chronic consumptive coagulopathies (DIC) 3
  • Consider therapeutic doses of unfractionated heparin (UFH) for thrombotic manifestations
  • Weight-adjusted dosing (e.g., 10 units/kg/hr) may be used without targeting specific APTT values 1
  • For patients with high bleeding risk, continuous infusion UFH is preferred due to its short half-life and reversibility 1

• Prophylactic anticoagulation:

  • In critically ill, non-bleeding DIC patients, prophylactic doses of heparin or LMWH are recommended for VTE prevention 1

Special Considerations

Antifibrinolytic Therapy

• Generally not recommended in DIC patients
• May be considered only in cases of primary hyperfibrinolytic DIC with severe bleeding (tranexamic acid 1g every 8 hours) 1

Monitoring and Follow-up

• Perform serial monitoring of coagulation parameters (platelet count, PT/INR, fibrinogen, D-dimer)
• Visually inspect for bleeding manifestations
• Monitor for thrombotic complications 1

Common Pitfalls to Avoid

• Overlooking the short lifespan of transfused products in active DIC
• Using antifibrinolytic agents without clear indication of hyperfibrinolytic DIC
• Using recombinant Factor VIIa, which carries thrombotic risks and lacks evidence in DIC
• Delaying treatment of the underlying disease
• Misinterpreting normal coagulation screens (normal PT/aPTT does not exclude DIC) 1

Phase-Dependent Approach

Recognize that DIC has phase-dependent characteristics:

• Initial prothrombotic phase may transition to hemostatic insufficiency
• Treatment approach should adapt to the predominant phase (thrombotic vs. hemorrhagic) 2
• Regular reassessment is essential as the clinical picture can rapidly change