From the Guidelines
Management of Disseminated Intravascular Coagulation (DIC) involves a multifaceted approach. The primary goal is to address the underlying cause of DIC, while also providing supportive care to manage bleeding and thrombotic complications.
Supportive Care
- In patients with DIC and active bleeding, platelet transfusion is suggested to maintain the platelet count above 50 x 10^9/L 1.
- Fresh frozen plasma (15-30 mL/kg) may be transfused with careful clinical monitoring to decide on dose adjustments, and prothrombin complex concentrates can be used in cases of concerns over volume overload 1.
- In actively bleeding cases with persistently low fibrinogen values (below 1.5 g/L), transfusion of two pools of cryoprecipitate or fibrinogen concentrate is suggested 1.
Anticoagulant Therapy
- Heparin, either unfractionated (UFH) or low-molecular-weight (LMWH), can be used to inhibit excess thrombin generation, but its use should be limited in highly prothrombotic forms of DIC, especially those associated with solid cancers 1.
- LMWH is preferred over UFH in most cases, but UFH may be chosen in patients with a high risk of bleeding and renal failure due to its easier reversibility 1.
Diagnostic Approach
- A two-step diagnostic approach is suggested, assessing first for sepsis-induced coagulopathy (SIC) and if SIC criteria are met, assessing for overt DIC 1.
- Early detection of DIC is crucial, as it can quickly progress to multi-organ failure and death 1.
It is essential to note that the management of DIC should be individualized, taking into account the underlying cause, severity of symptoms, and patient-specific factors. Additionally, the use of anticoagulant therapies, such as antithrombin and recombinant soluble thrombomodulin, may vary depending on the country and availability of these agents 1.
From the Research
Management of Disseminated Intravascular Coagulation (DIC)
The management of DIC involves several key strategies, including:
- Treatment of the underlying condition triggering the coagulopathy, as emphasized by 2, 3, 4
- Supportive haemostatic and antithrombotic treatment, with the goal of minimizing the risk of bleeding and thrombosis, as discussed in 2, 5, 6
- Individualized management based on the type of underlying disease, presence of bleeding or thrombotic complications, and laboratory test results, as recommended by 2
Supportive Management
Supportive management of DIC may include:
- Platelet transfusion to maintain a platelet count > 50×10⁹/l in cases of bleeding, or > 20-30×10⁹/l in cases without bleeding, as suggested by 2
- Thromboprophylaxis with low-molecular-weight heparin until bleeding ensues or platelet count drops below 30×10⁹/l, as advised by 2
- Transfusion of blood products to minimize the risk of bleeding, with more liberal use in certain types of leukemia, such as acute promyelocytic leukemia (APL), as discussed in 4
Treatment Strategies
Treatment strategies for DIC may vary depending on the underlying cause and clinical manifestations, but may include:
- Elimination of tissue factor-mediated thrombin generation, as mentioned in 5
- Restitution of normal anticoagulant function, as discussed in 5
- Anticoagulation therapy, as part of supportive care, as mentioned in 6
- Early administration of specific treatments, such as all-trans retinoic acid in APL, as highlighted in 4