Thromb Haemost 2016; 115(05): 896-904
DOI: 10.1160/TH15-09-0740
Consensus Paper
Schattauer GmbH

Supportive management strategies for disseminated intravascular coagulation

An international consensus
Alessandro Squizzato
1  Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy
,
Beverley J. Hunt
2  Department of Haematology, Pathology and Lupus, Guy’s & St Thomas’ NHS Foundation Trust, London, UK
,
Gary T. Kinasewitz
3  Pulmonary and Critical Care Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
,
Hideo Wada
4  Department of Molecular and Laboratory Medicine, Mie University School of Medicine, Mie, Japan
,
Hugo ten Cate
5  Department of Internal Medicine and Cardiovascular Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands
,
Jecko Thachil
6  Department of Haematology, Manchester Royal Infirmary, Manchester, UK
,
Marcel Levi
7  Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
,
Vicente Vicente
8  Division of Hematology and Clinical Oncology, Hospital Universitario Morales Meseguer, Murcia, Spain
,
Armando D’Angelo
9  Coagulation Service and Thrombosis Research Unit, Scientific Institute San Raffaele, Milano, Italy;
,
Marcello Di Nisio
7  Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
10  Department of Medical, Oral, and Biotechnological Sciences, Università “G. D’Annunzio” of Chieti-Pescara, Chieti, Italy
› Author Affiliations
Further Information

Publication History

Received: 19 September 2015

Accepted after major revision: 02 December 2015

Publication Date:
06 December 2017 (online)

Summary

The cornerstone of the management of disseminated intravascular coagulation (DIC) is the treatment of the underlying condition triggering the coagulopathy. However, a number of uncertainties remain over the optimal supportive treatment. The aim of this study was to provide evidence and expert-based recommendations on the optimal supportive haemostatic and antithrombotic treatment strategies for patients with DIC. A working group defined five relevant clinical scenarios. Published studies were systematically searched in the MEDLINE and EMBASE databases (up to May 2014). Seven internationally recognised experts were asked to independently provide clinical advice. A two-phase blinded data collection technique was used to reach consensus. Only three randomised controlled trials (RCTs) on the supportive management of DIC were identified. The RCTs (overall less than 100 patients) investigated the use of fresh frozen plasma and platelet transfusion and found no differences in survival between the intervention and control groups. The experts’ approach was heterogeneous, although there was consensus that supportive management should vary according to the underlying cause, clinical manifestations and severity of blood test abnormalities. Platelet transfusion should be given to maintain platelet count > 50×109/l in case of bleeding while a lower threshold of 20 to 30×109/l may be used in DIC without bleeding. Thromboprophylaxis with low-molecular-weight heparin is advised until bleeding ensues or platelet count drops below 30×109/l. In conclusion, in the absence of solid evidence from RCTs, an individualised supportive management of DIC is advisable based on the type of underlying disease, presence of bleeding or thrombotic complications and laboratory tests results.

Supplementary Material to this article is available online at www.thrombosis-online.com.