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2212 Part XII: Hemostasis and Thrombosis Chapter 129: Disseminated Intravascular Coagulation 2213

Diagnosis of DIC

Vigorously treat underlying
disease, correct hypotension,
tissue perfusion, acidosis, and
hypoxia

Suggestive evidence of DIC— Unequivocal evidence of DIC—
score less than 5 score 5 or more

Consider replacement therapy
and/or continuous heparin infusion Consider only
in cases with: replacement therapy
Major thromboembolism in all cases but
Wait for success of Consider waiting for Consider APC Purpura fulminans particularly in those
treatment but be alert to success of treatment if infusion in sepsis Acute promyelocytic leukemia with:
deterioration patient’s condition is Hemangioma Brain gunshot injury
stable
Aneurysm (before surgery) Emergency surgery
Amniotic fluid embolism Abruptio placentae
Septic abortion Severe bleeding
Dead fetus (prior to evacuation)

Every 6–8 hours
reevaluate clinical and
laboratory parameters

If bleeding is the major problem:

Give replacement therapy every 8 hours
If above fails, consider adding
If improved, continue same continuous heparin infusion If thromboembolism is the
treatment until recovery If concomitant primary fibrinolysis major problem, consider
is evident, consider adding an continuous heparin
antifibrinolytic agent with heparin infusion

Figure 129–4. General guidelines for initial treatment and follow up of patients with disseminated intravascular coagulation (DIC). The success
of management is related to taking rapid, vigorous measures against the underlying disease, support of vital functions, close clinical observation,
thoughtful consideration in each individual patient, availability of 24-hour coagulation laboratory services, and an adequate supply of platelet
concentrate, cryoprecipitate, fresh-frozen plasma, and packed red cells for replacement therapy. Heparin, when indicated, should be adminis-
tered by continuous infusion. The basis and limitations of each of the outlined recommendations are detailed throughout the text. APC, activated
protein C.

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