Disseminated Intravascular Coagulation in Intensive Care Unit Diagnosis and Treatment

Abstract

Summary T he International Society on Thrombosis and Hemostasis has suggested the following definition for DIC: “An acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes. It can originate from and cause damage to the microvasculature, which if sufficiently severe, can produce organ dysfunction.” DIC is estimated to be present in as many as 1% of hospitalized patients. DIC is not itself a specific illness; rather, it is a complication or an effect of the progression of other illnesses. It is always secondary to an underlying disorder and is associated with a number of clinical conditions, generally involving activation of systemic inflammation. Most common conditions include (Sepsis and severe infection - Trauma (neurotrauma) - Obstetric complications (amniotic fluid embolism; hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome; eclampsia; Retained dead fetus syndrome). Disseminated intravascular coagulation (DIC) is categorized into bleeding, organ failure, massive bleeding, and non-symptomatic types according to the sum of vectors for hypercoagulation and hyperfibrinolysis. The British Committee for Standards in Hematology, Japanese Society of Thrombosis and Hemostasis, and the Italian Society for Thrombosis and Hemostasis published separate guidelines for DIC; however, there are several differences between these three sets of guidelines. Therefore, the International Society of Thrombosis and Hemostasis (ISTH) recently harmonized these differences and published the guidance of diagnosis and treatment for DIC. Treatment of underlying conditions is recommended in three types of DIC, with the exception of massive bleeding. Blood transfusions are recommended in patients with the bleeding and massive bleeding types of DIC. Meanwhile, treatment with heparin is recommended in those with the non-symptomatic type of DIC. The administration of synthetic protease inhibitors and antifibrinolytic therapy is recommended in patients with the bleeding and massive bleeding types of DIC. Furthermore, the administration of natural protease inhibitors is recommended in patients with the organ failure type of DIC, while antifibrinolytic treatment is not. The diagnosis and treatment of DIC should be carried out in accordance with the type of DIC.