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

From the Guidelines

The treatment of Disseminated Intravascular Coagulation (DIC) should focus on addressing the underlying cause and providing supportive care with blood component therapy, including platelet transfusions to maintain a platelet count above 50 x 10^9/L, fresh frozen plasma to replace depleted coagulation factors, and cryoprecipitate to maintain fibrinogen levels above 1.5 g/L, as suggested by the guidance from the SSC of the ISTH 1.

Key Components of Treatment

• Identifying and treating the underlying cause of DIC, such as sepsis, trauma, malignancy, or obstetric complications
• Blood component therapy:
  • Platelet transfusions: to maintain a platelet count above 50 x 10^9/L, especially in patients with active bleeding 1
  • Fresh frozen plasma: 15-30 mL/kg to replace depleted coagulation factors, with careful clinical monitoring to decide on dose adjustments 1
  • Cryoprecipitate: to maintain fibrinogen levels above 1.5 g/L, especially in cases of severe bleeding 1

Considerations for Anticoagulation

• Anticoagulation with heparin may be considered in cases of predominant thrombosis or when fibrinogen levels continue to fall despite replacement therapy, though this remains controversial 1
• The choice of heparin, either unfractionated or low-molecular-weight, should be based on the patient's risk of bleeding and renal function 1

Monitoring and Adjustments

• Continuous monitoring of coagulation parameters, including platelet count, PT/INR, aPTT, fibrinogen, and D-dimer levels, is essential to guide therapy and assess response 1
• Dose adjustments should be made based on clinical response and laboratory results, taking into account the potential for short lifespan of transfused platelets and fibrinogen in patients with vigorous coagulation activation and fibrinolysis 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)

Recommended Adult Dosages: • Therapeutic Anticoagulant Effect with Full-Dose Heparin† (2. 3) Deep Subcutaneous (Intrafat) Injection Use a different site for each injection Initial Dose 5,000 units by intravenous injection followed by 10,000 to 20,000 units of a concentrated solution, subcutaneously Every 8 hours or Every 12 hours 8,000 to 10,000 units of a concentrated solution15,000 to 20,000 units of a concentrated solution Intermittent Intravenous Injection Initial Dose 10,000 units, either undiluted or in 50 to 100 mL of0.9% Sodium ChlorideInjection, USP Every 4 to 6 hours 5,000 to 10,000 units, either undiluted or in 50 to 100 mL of 0.9% Sodium Chloride Injection,USP Intravenous Infusion Initial Dose 5,000 units by intravenous injection Continuous 20,000 to 40,000 units/24 hours in 1,000 mL of 0. 9% Sodium Chloride Injection, USP

The treatment for Disseminated Intravascular Coagulation (DIC) is Heparin Sodium Injection. The recommended dosages are:

• Deep Subcutaneous (Intrafat) Injection: Initial dose of 5,000 units by intravenous injection followed by 10,000 to 20,000 units of a concentrated solution, subcutaneously every 8 hours or every 12 hours.
• Intermittent Intravenous Injection: Initial dose of 10,000 units, either undiluted or in 50 to 100 mL of 0.9% Sodium Chloride Injection, USP, every 4 to 6 hours.
• Intravenous Infusion: Initial dose of 5,000 units by intravenous injection, continuous 20,000 to 40,000 units/24 hours in 1,000 mL of 0.9% Sodium Chloride Injection, USP 2.

From the Research

Treatment Overview

The treatment of Disseminated Intravascular Coagulation (DIC) primarily focuses on addressing the underlying condition that triggered the coagulopathy, as well as providing supportive care to manage the symptoms and prevent further complications 3, 4, 5.

Supportive Care

Supportive care measures include:

• Transfusion of platelets or plasma components in patients with DIC who are bleeding or at high risk of bleeding 4.
• Administration of fresh frozen plasma (FFP) in bleeding patients with prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) 4.
• Use of factor concentrates, such as prothrombin complex concentrate, in patients with bleeding who cannot receive FFP due to fluid overload 4.
• Treatment of severe hypofibrinogenemia with fibrinogen concentrate or cryoprecipitate 4.

Anticoagulation Therapy

Anticoagulation therapy may be considered in certain cases, such as:

• Therapeutic doses of heparin in patients with thrombosis-predominant DIC, such as arterial or venous thromboembolism 4, 6.
• Prophylactic doses of heparin or low-molecular-weight heparin in critically ill, non-bleeding patients with DIC to prevent venous thromboembolism 4.

Other Therapies

Other therapies that have been investigated or used in the treatment of DIC include:

• Recombinant human activated protein C (rhAPC) in patients with severe sepsis and DIC, although its use is limited due to the risk of bleeding 3, 4.
• Antithrombin concentrate, although its use is not recommended due to lack of evidence supporting its effectiveness 4.
• Antifibrinolytic agents, such as tranexamic acid, in patients with primary hyperfibrinolytic state and severe bleeding 4.

Monitoring and Individualized Care

It is essential to monitor patients with DIC closely and adjust treatment according to their individual needs, underlying condition, and laboratory results 4, 5.