Is Inj Lyfaquin (Tranexamic acid) used in the management of Disseminated Intravascular Coagulation (DIC)?

Use of Tranexamic Acid (Inj Lyfaquin) in Disseminated Intravascular Coagulation (DIC)

Tranexamic acid is not recommended for routine use in DIC and should be avoided except in very specific circumstances of hyperfibrinolytic DIC with therapy-resistant bleeding. 1

General Principles for DIC Management

• The cornerstone of DIC management is treating the underlying condition (e.g., cancer, sepsis, trauma) 1
• Regular clinical and laboratory surveillance is essential to monitor disease progression and treatment response 1
• Prophylactic anticoagulation is recommended in most patients with cancer-related DIC (except hyperfibrinolytic DIC) in the absence of contraindications 1
• Therapeutic-dose anticoagulation should be used in patients who develop arterial or venous thrombosis 1

Tranexamic Acid in DIC: Evidence and Recommendations

When NOT to Use Tranexamic Acid:

• Routine use of tranexamic acid in DIC is strongly discouraged due to increased thrombotic risks 1
• Tranexamic acid is contraindicated in patients with active intravascular clotting, which is the hallmark of most DIC cases 2
• Non-hyperfibrinolytic forms of DIC should not be treated with tranexamic acid as it may worsen outcomes 1, 3

Limited Indications for Tranexamic Acid:

• Tranexamic acid may be considered only in hyperfibrinolytic DIC when therapy-resistant bleeding dominates the clinical picture 1
• APTEM testing (thromboelastometric monitoring) should be used to confirm hyperfibrinolysis before administering tranexamic acid 3
• The recommended dosing in such cases is 10-15 mg/kg loading dose followed by 1-5 mg/kg/hour infusion 3

Risks and Monitoring

• Tranexamic acid increases the risk of thromboembolic events, which is particularly concerning in DIC where thrombosis is already a major risk 2
• Venous and arterial thrombosis or thromboembolism has been reported in patients treated with tranexamic acid 2
• Other potential adverse effects include seizures, hypersensitivity reactions, visual disturbances, and dizziness 2
• If tranexamic acid is used, close monitoring for thrombotic complications is essential 2

Case-Specific Considerations

• While some case reports suggest successful use of tranexamic acid in specific DIC scenarios 4, 5, 6, 7, these represent exceptions rather than the rule
• The International Society on Thrombosis and Haemostasis (ISTH) guidelines, which represent the highest level of evidence, recommend against routine use 1
• Any consideration of tranexamic acid use should be preceded by careful assessment of the DIC subtype and confirmation of hyperfibrinolysis 3, 8

Alternative Approaches

• For bleeding management in DIC, consider:
  • Platelet transfusions for counts <50 × 10^9/L in bleeding patients 8
  • Fresh frozen plasma for prolonged PT and aPTT in actively bleeding patients 8
  • Fibrinogen concentrate or cryoprecipitate for severe hypofibrinogenemia (<1 g/L) that persists despite FFP 8
• For thrombosis management in DIC, consider therapeutic doses of heparin, preferably unfractionated heparin due to its short half-life and reversibility 8