How is disseminated intravascular coagulation (DIC) treated?

Updated: Oct 28, 2019
  • Author: Muhammad A Mir, MD, FACP; Chief Editor: Perumal Thiagarajan, MD  more...
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Answer

Answer

The treatment of DIC can be divided into the following components:

  1.  Treatment of the underlying disorder
  2. Supportive management of bleeding complications
  3. Treatment aimed at the coagulation process

The triggering underlying disease must be treated aggressively. This may requireinterventions such as surgical drainage of an abscess or necrotic tissue, antibiotic therapy, control of temperature, and volume replacement. Early recognition and treatment of DIC is the key to success, so a high index of clinical suspicion must be maintained.

Continued DIC is characterized by a consumption coagulopathy of platelets. Ongoing bleeding or rapid hemorrhage may lead to anemia. These deficiencies can be corrected by platelet transfusions and administration of cryoprecipitate (to replete fibrinogen) and FFP.

Heparin may be cautiously used if thrombosis is the predominant manifestation, although this is easier said than done in the presence of ongoing bleeding.

A trial of low molecular weight dalteparin compared to unfractionated heparin showed less bleeding and better organ system scores, but it demonstrated no survival benefit. [75] Generally, the earlier treatment is initiated, the better the patient's prognosis. [65]

The utility of antithrombin III treatment for DIC is still unknown. A meta-analysis of 122 subjects included in 3 placebo-controlled, randomized studies of antithrombin III therapy for severe sepsis showed a 22% reduction in 30-day all-cause mortality and a reduction in the length of stay in the intensive care unit in the antithrombin III–treated group. Although antithrombin III treatment significantly decreased the risk of death in one study, the aggregate results were not statistically significant. [76, 77, 78]

Hoffmann and colleagues recently reported that a 14-day course of antithrombin administration in septic patients normalized global coagulation tests and increased prothrombin activity as well as fibrinogen concentration, reflecting less coagulation factor consumption when compared with untreated controls. Unfortunately, the treatment had no impact on survival. [79]

These trials of coagulation inhibitors have been conducted in patients with sepsis, not DIC per se. Although coagulation inhibitors may be shown to play an important role in selected subgroups of patients, their efficacy and safety remain to be proven. [80]

Recombinant activated human factor VII (rFVIIa) continues to show promise in patients with coagulopathy from trauma, DIC, postpartum bleeding, sepsis, and postoperative hemorrhage. [81, 82, 83, 84] Laffan et al stopped or reduced pancreatitis-associated bleeding in 11 of 12 patients, but the treatment had no impact on overall survival. [85] Lim et al used the drug successfully in 7 patients with amniotic embolism–induced bleeding. [86] These results point out that more controlled trials are needed to understand both the timing and the effective dose of rFVIIa.

Recombinant human thrombomodulin alpha (rTM), which acts as an inhibitor of thrombin, has shown some benefit in thrombosis-predominant patients with DIC, but bleeding remains a concern and use is not widespread. [87]


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