Which medications in the drug class Anticoagulants, Hematologic are used in the treatment of Disseminated Intravascular Coagulation (DIC)?

Updated: Dec 06, 2020
  • Author: Marcel M Levi, MD; Chief Editor: Srikanth Nagalla, MBBS, MS, FACP  more...
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Answer

Anticoagulants, Hematologic

Anticoagulants are used in the treatment of clinically evident intravascular thrombosis when the patient continues to bleed or clot 4-6 hours after initiation of primary and supportive therapy. Thrombosis can present as purpura fulminans or acral ischemia. Take special precaution in obstetric emergencies or massive liver failure. The anti-inflammatory properties of antithrombin may be particularly useful in DIC secondary to sepsis.

Heparin is the only currently available antithrombotic drug that has a role in the treatment of patients with DIC. Although most experience is with standard heparin, low-molecular-weight heparins (LMWHs) are increasingly used. Moreover, although LMWHs usually do not require laboratory monitoring, it may be advisable to check anti-factor Xa levels in critically ill patients with serious renal failure.

Heparin

Heparin augments the activity of antithrombin and prevents conversion of fibrinogen to fibrin. It does not actively lyse but is able to inhibit further thrombogenesis. It prevents reaccumulation of clot after spontaneous fibrinolysis. Usage and dosing of heparin are based on the severity of DIC, the underlying cause, and the extent of thrombosis. Monitoring the results of therapy is mandatory.

Antithrombin (Atryn, Thrombate III)

Antithrombin is used for moderately severe–to–severe DIC or when levels are depressed markedly. It is an alpha2-globulin that inactivates thrombin, plasmin, and other serine proteases of coagulation, including factors IXa, Xa, XIa, XIIa, and VIIa. These effects inhibit coagulation.


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