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 appropriate blood product support based on bleeding status and laboratory parameters. 1

Diagnostic Approach

Before initiating treatment, confirm DIC diagnosis using the ISTH scoring system:

Parameter	Score	Range
Platelet count (×10⁹/L)	2	<50
	1	≥50, <100
Fibrin-related markers (D-dimer/FDP)	3	Strong increase
	2	Moderate increase
Prothrombin time (PT)	2	≥6 seconds prolongation (PT ratio >1.4)
	1	≥3 seconds, <6 seconds prolongation (PT ratio >1.2, ≤1.4)
Fibrinogen (g/L)	1	<1.0

• A score ≥5 confirms DIC diagnosis 1

Treatment Algorithm

Step 1: Treat the Underlying Cause

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

Step 2: Blood Product Support Based on Clinical Presentation

For Actively Bleeding Patients:

1. Platelet Transfusion:

   • Maintain platelet count >50 × 10⁹/L 1
   • Target higher platelet count (>100 × 10⁹/L) for CNS injury or multiple trauma 1

2. Fresh Frozen Plasma (FFP):

   • Administer 15-30 mL/kg with careful clinical monitoring 1
   • Consider prothrombin complex concentrates if volume overload is a concern 1

3. Fibrinogen Replacement:

   • If fibrinogen remains <1.5 g/L despite other measures, administer:
     • Two pools of cryoprecipitate (when available) OR
     • Fibrinogen concentrate 1

For Non-Bleeding Patients with High Bleeding Risk:

• Maintain platelet count >20-30 × 10⁹/L 1
• Consider prophylactic FFP before invasive procedures 2
• Provide thromboprophylaxis with low molecular weight heparin until bleeding occurs or platelet count drops below 30×10⁹/L 3

Step 3: Specific Interventions Based on DIC Type

For DIC Where Thrombosis Predominates:

• Consider therapeutic doses of heparin, particularly for:
  • Arterial or venous thromboembolism
  • Severe purpura fulminans with acral ischemia
  • Vascular skin infarction 2
• Continuous infusion unfractionated heparin (10 units/kg/h) may be preferred due to short half-life and reversibility 2

For DIC with Hyperfibrinolysis and Severe Bleeding:

• Consider antifibrinolytic agents like tranexamic acid (1g every 8 hours) 2
• Note: Antifibrinolytics should generally be avoided in most DIC cases 2

Special Considerations

Heparin Use in DIC

• Heparin is specifically indicated for treatment of acute and chronic consumptive coagulopathies (DIC) 4
• For therapeutic effect, follow recommended dosing:
  • Initial dose: 5,000 units IV followed by 10,000-20,000 units subcutaneously
  • Maintenance: 8,000-10,000 units subcutaneously every 8 hours or 15,000-20,000 units every 12 hours 4

Laboratory Monitoring

• Monitor platelet count, PT/INR, fibrinogen, and D-dimer regularly
• Repeat testing every 4-6 hours initially to assess treatment response 1
• Monitor for occult blood in stool throughout treatment 4

Common Pitfalls to Avoid

• Overlooking the short lifespan of transfused products in active DIC - frequent reassessment is necessary 1
• Using antifibrinolytic agents without clear indication of hyperfibrinolytic DIC 1
• Delaying treatment of the underlying disease - this should be the primary focus 1
• Misinterpreting normal coagulation screens - a normal PT/aPTT does not exclude DIC 1
• Relying solely on INR for non-warfarin patients - INR was designed specifically for warfarin monitoring 1

By following this structured approach to DIC management with emphasis on treating the underlying cause while providing appropriate blood product support, outcomes can be significantly improved.