DIC Treatment

        Treatment of disseminated intravascular coagulation (DIC) is controversial, but treatment guidelines have been published. Treatment should primarily focus on addressing the underlying disorder. DIC can result from numerous clinical conditions, including sepsis, trauma, obstetric emergencies, and malignancy. Surgical management is limited to primary treatment of certain underlying disorders.

Management of the DIC itself has the following basic features:

• Monitor vital signs
• Assess and document the extent of hemorrhage and thrombosis
• Correct hypovolemia
• Administer basic hemostatic procedures when indicated

         Platelet and factor replacement should be directed not at simply correcting laboratory abnormalities but at addressing clinically relevant bleeding or meeting procedural needs. Heparin should be provided to those patients who demonstrate extensive fibrin deposition without evidence of substantial hemorrhage; it is usually reserved for cases of chronic DIC. Heparin is appropriate to treat the thrombosis that occurs with DIC. It also has a limited use in acute hemorrhagic DIC in a patient with a self-limited condition of acral cyanosis and digital ischemia.

         Administration of activated protein C (drotrecogin alfa) showed benefit in subgroups of patients with sepsis who have DIC, with consideration given to the anticoagulant effects of this agent. However, drotrecogin alfa was withdrawn from the worldwide market on October 25, 2011, after the PROWESS-SHOCK trial failed to show a survival benefit for patients with severe sepsis and septic shock^.

       Patients with DIC should be treated at hospitals with appropriate critical care and subspecialty expertise, such as hematology, blood bank, or surgery. Patients who present to hospitals without those capabilities and who are stable enough for transfer should be referred expeditiously to a hospital that has those resources. 

       The management of acute and chronic forms of disseminated intravascular coagulation (DIC) should primarily be directed at treatment of the underlying disorder. Often, the DIC component will resolve on its own once the underlying disorder is addressed.
For example, if infection is the underlying etiology, the appropriate administration of antibiotics and source control is the first line of therapy. As another example, in case of an obstetric catastrophe, the primary approach is to deliver appropriate obstetric care, in which case the DIC will rapidly subside. If the underlying condition causing DIC is not known, a diagnostic workup should be initiated. Most patients with acute DIC require critical care treatment appropriate for the primary diagnosis, occasionally including emergency surgery.
      A DIC scoring system has been proposed by Bick to assess the severity of the coagulopathy as well as the effectiveness of therapeutic modalities^. Clinical and laboratory parameters are measured with regularity.