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

From the Guidelines

Disseminated intravascular coagulation (DIC) treatment should prioritize addressing the underlying condition causing DIC, with supportive care including platelet transfusions for counts below 50,000/μL with active bleeding, and fresh frozen plasma for depleted clotting factors, as recommended by the most recent guidance from the SSC of the ISTH 1. The primary goal in managing DIC is to treat the underlying cause, which could be an infection, trauma, or malignancy, while providing supportive care to manage the coagulopathy.

• Key aspects of supportive care include:
  • Platelet transfusions to maintain a platelet count above 50,000/μL in patients with active bleeding, as suggested by guidance statements 1.
  • Transfusion of fresh frozen plasma (15–30 mL/kg) with careful clinical monitoring for dose adjustments, especially in cases of active bleeding, as recommended by 1.
  • Use of prothrombin complex concentrates in cases of concerns over volume overload, as an alternative to fresh frozen plasma 1.
  • Transfusion of cryoprecipitate or fibrinogen concentrate in cases with persistently low fibrinogen values (below 1.5 g/L) despite supportive measures, as suggested by 1. It's crucial to monitor the patient's condition closely, including coagulation parameters, complete blood count, and organ function, to adjust the treatment plan as necessary.
• The use of anticoagulation therapy, such as heparin, should be considered on a case-by-case basis, particularly in patients with predominant thrombosis, as recommended by 1.
• Antifibrinolytic agents like tranexamic acid are generally contraindicated due to the risk of thrombosis but may be considered in specific situations with predominant hyperfibrinolysis, as noted in 1. Overall, the management of DIC requires a balanced approach, considering both the risk of thrombosis and bleeding, and should be guided by the most recent and highest quality evidence available, such as the guidance from the SSC of the ISTH 1.

From the FDA Drug Label

Heparin Sodium Injection is indicated for: • Prophylaxis and treatment of venous thrombosis and pulmonary embolism; • Prevention of postoperative deep venous thrombosis and pulmonary embolism in patients undergoing major abdominothoracic surgery or who, for other reasons, are at risk of developing thromboembolic disease; • Atrial fibrillation with embolization; • Treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation); • Prevention of clotting in arterial and cardiac surgery; • Prophylaxis and treatment of peripheral arterial embolism. • Anticoagulant use in blood transfusions, extracorporeal circulation, and dialysis procedures.

The treatment for DIC (Disseminated Intravascular Coagulation) is heparin, as it is indicated for the treatment of acute and chronic consumptive coagulopathies (disseminated intravascular coagulation) 2, 2, 3.

• Key points:
  • Heparin is used to treat DIC.
  • The dosage and administration of heparin vary depending on the patient's condition and the specific product being used.
  • It is essential to monitor the patient's blood coagulation tests and adjust the dose accordingly.

From the Research

Overview of DIC Treatment

• The cornerstone of DIC treatment is addressing the underlying condition that triggered the coagulation disorder 4, 5, 6, 7.
• Treatment strategies for DIC focus on supportive care, anticoagulation therapy, and other supportive measures to manage the condition and prevent further complications.

Supportive Care and Transfusion Therapy

• Transfusion of platelets or plasma (components) in patients with DIC should not primarily be based on laboratory results and should in general be reserved for patients who present with bleeding 4.
• In patients with DIC and bleeding or at high risk of bleeding, transfusion of platelets should be considered if the platelet count is <50 x 10(9)/l 4.
• Fresh frozen plasma (FFP) may be useful in bleeding patients with DIC and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT) 4, 8.
• Fibrinogen concentrate or cryoprecipitate may be used to treat severe hypofibrinogenaemia (<1 g/l) that persists despite FFP replacement 4.

Anticoagulation Therapy

• Therapeutic doses of heparin should be considered in cases of DIC where thrombosis predominates, such as arterial or venous thromboembolism 4.
• Prophylactic doses of heparin or low molecular weight heparin are recommended for critically ill, non-bleeding patients with DIC to prevent venous thromboembolism 4.
• Recombinant human activated protein C may be considered for patients with severe sepsis and DIC, but its use is not recommended for patients at high risk of bleeding 4, 5.

Other Therapeutic Approaches

• Antithrombin concentrate is not recommended for patients with DIC in the absence of further prospective evidence from randomized controlled trials confirming its beneficial effect 4, 5.
• Antifibrinolytic agents are not recommended for patients with DIC, except in cases of primary hyperfibrinolytic state with severe bleeding, where lysine analogues such as tranexamic acid may be used 4.