Disseminated intravascular coagulation Treatment
Treatment for disseminated intravascular coagulation (DIC) depends on the medical condition causing it, because this underlying cause predicts the probable outcome. Therapy should be appropriately aggressive for the patient's age, disease, and severity and location of hemorrhage/thrombosis. Treatment for DIC includes anticoagulants, blood components, and antifibrinolytics.
Anticoagulants are given exceedingly rarely when thrombus formation is likely to lead to imminent death (such as in coronary artery thrombosis or cerebrovascular thrombosis). Anticoagulants are used in the treatment of clinically evident intravascular thrombosis when the patient continues to bleed or clot 4-6 h 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.
When the primary disease cannot be treated, intravenous injections of heparin, a medication used to prevent thrombosis, are sometimes used in combination with replacement therapy. The use of heparin is, however, very controversial because it can cause bleeding itself.
Antithrombin III are used for moderately severe DIC or when levels are depressed markedly. Alpha 2-globulin that inactivates thrombin, plasmin, and other serine proteases of coagulation, including factors IXa, Xa, XIa, XIIa, and VIIa. These effects inhibit coagulation.
In some situations, infusion with antithrombin may be necessary. A new development is drotrecogin alfa (Xigris), a recombinant activated protein C product. Activated Protein C (APC) deactivates clotting factors V and VIII, and the presumed mechanism of action of drotrecogin is the cessation of the intravascular coagulation. Due to its high cost and its severe adverse effects, it is only used strictly on indication in intensive care patients with severe sepsis.
The next step is to replace missing blood components. Blood components are used to correct abnormal hemostatic parameters. These products should be considered only after initial supportive and anticoagulant therapy. If your platelet levels are low, platelet transfusions are appropriate. If plasma coagulation factors are decreased, they may be replaced with fresh frozen plasma. If fibrinogen levels are low, the doctor might consider transfusion with cryoprecipitate or fibrinogen, which is a substance rich in fibrinogen.
Antifibrinolytics may be useful in cases of DIC secondary to hyperfibrinolysis associated with acute promyelocytic leukemia and other forms of cancer. Antifibrinolytics such as aminocaproic acid are also of value. Therapy to stop the coagulation cascade requires an understanding of the mechanisms involved and is promising.