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

From the Guidelines

Treatment of Disseminated Intravascular Coagulation (DIC) should primarily focus on addressing the underlying cause while providing supportive care to manage coagulation abnormalities, with the most recent guidance suggesting the use of platelet transfusion to maintain the platelet count above 50 x 10^9/L in patients with active bleeding, as recommended by the SSC of the ISTH 1. The first step is to identify and aggressively treat the triggering condition, which may include sepsis, trauma, malignancy, or obstetric complications.

• Supportive measures include:
  • Blood component therapy with fresh frozen plasma (15–30 mL/kg) to replace depleted coagulation factors, as suggested by 1
  • Platelet transfusions to maintain the platelet count above 50 x 10^9/L in patients with active bleeding, as recommended by 1
  • Cryoprecipitate to maintain fibrinogen levels, with two pools of cryoprecipitate (whenever available) or fibrinogen concentrate suggested for actively bleeding cases with persistently low fibrinogen values (below 1.5 g/L) despite these supportive measures, as recommended by 1
• In cases of severe bleeding, red blood cell transfusions may be necessary.
• Anticoagulation with unfractionated heparin or low-molecular-weight heparin may be considered in cases of predominant thrombosis, as discussed in 1.
• Continuous monitoring of coagulation parameters (PT, PTT, fibrinogen, D-dimer, platelet count) is essential to guide therapy, with regular clinical and laboratory surveillance recommended to assess the improvement or worsening of the patient, as suggested by 1. DIC requires this comprehensive approach because it involves both excessive clotting that consumes coagulation factors and platelets, leading paradoxically to bleeding complications, while also causing microvascular thrombosis that can damage organs.
• The use of anticoagulant factor concentrates, such as antithrombin, activated protein C, and soluble thrombomodulin, may be beneficial in specific scenarios, as discussed in 1.
• Prophylactic anticoagulation is recommended in all patients with cancer-related DIC, except hyperfibrinolytic DIC, in the absence of contraindications, as recommended by 1.

From the FDA Drug Label

Heparin Sodium Injection is indicated for: • Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation);

The treatment for Disseminated Intravascular Coagulation (DIC) with heparin involves administering the drug via intermittent intravenous injection, intravenous infusion, or deep subcutaneous injection.

• The initial dose for intermittent intravenous injection is 10,000 units, either undiluted or in 50 to 100 mL of 0.9% Sodium Chloride Injection, USP, every 4 to 6 hours, with 5,000 to 10,000 units thereafter.
• For intravenous infusion, the initial dose is 5,000 units by intravenous injection, followed by a continuous infusion of 20,000 to 40,000 units/24 hours in 1,000 mL of 0.9% Sodium Chloride Injection, USP.
• The dosage should be adjusted based on laboratory monitoring, with periodic monitoring of platelet counts, hematocrit, and occult blood in stool during the entire course of heparin therapy 2, 2.
• It is essential to confirm the choice of the correct Heparin Sodium Injection vial to ensure that the 1 mL vial is not confused with a “catheter lock flush” vial or other 1 mL vial of incorrect strength 2.
• Contraindications for heparin use include a history of heparin-induced thrombocytopenia (HIT) or heparin-induced thrombocytopenia and thrombosis (HITTS), known hypersensitivity to heparin or pork products, and an uncontrolled bleeding state, except when this is due to disseminated intravascular coagulation 2.

From the Research

Treatment Options for Disseminated Intravascular Coagulation (DIC)

The treatment of DIC involves addressing the underlying cause and managing the symptoms. The following are some treatment options:

• Transfusion of blood products, such as platelets and clotting factors, to replace consumed components 3, 4, 5
• Administration of heparin to prevent further clotting 3, 4
• Use of antithrombin III to inhibit thrombin generation 3
• Administration of antifibrinolytic agents to prevent excessive bleeding 3, 4
• Use of synthetic protease inhibitors to control activation of blood coagulation 4
• Administration of natural protease inhibitors, such as antithrombin, to patients with organ failure type of DIC 4

Treatment Strategies Based on DIC Type

The treatment strategy may vary depending on the type of DIC:

• Bleeding type: transfusion of blood products, administration of antifibrinolytic agents, and use of synthetic protease inhibitors 4
• Massive bleeding type: transfusion of blood products, administration of antifibrinolytic agents, and use of synthetic protease inhibitors 4
• Organ failure type: administration of natural protease inhibitors, such as antithrombin 4
• Non-symptomatic type: treatment with heparin 4

Importance of Underlying Cause Treatment

Treatment of the underlying cause of DIC is crucial for improving patient outcomes:

• Timely and accurate diagnosis of DIC and its underlying condition is essential for prognosis 6
• Treatment should primarily focus on the underlying cause of DIC, with supportive treatment individualized according to the underlying aetiology, patient's symptoms, and laboratory records 6