When is heparin indicated in the treatment of DIC in sepsis/septic shock?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Answer

Therapeutic doses of heparin should be considered in the following clinical situations of DIC [111] :

  • When thrombosis predominates (eg, arterial or venous thromboembolism)

  • In the presence of severe purpura fulminans with associated inadequate perfusion to the extremities

  • In the presence of vascular skin infarction

Continuous infusion of UFH should be considered in patients with DIC who are at high risk of bleeding; for example, weight-adjusted doses (eg, 10 U/kg/hr) “may be used without the intention to prolong the aPTT ratio to 1.5-2.5 times the control.” [111] Close monitoring of these patients is required for signs of bleeding and for their aPTT measurements.

DVT prophylaxis with prophylactic doses of heparin or LMWH is recommended for critically ill patients with DIC who are not actively bleeding. [111]


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