Disseminated Intravascular Coagulation (DIC) 

 

 

Considerations

 

  • Emergency: mobilize resources & delegate tasks

  • Search for & correct precipitant:

    • Obstetrical hemorrhage, placental abruption, amniotic fluid embolism, pregnancy-induced hypertension

    • Trauma/burns

    • Transfusion

    • Sepsis

  • Aggressive treatment: potential for massive transfusion:

    • Hypothermia

    • Hypocalcemia

    • Factor dilution

    • Thrombocytopenia

    • Acidosis

    • Volume overload (acute respiratory distress syndrome, acute lung injury)

  • Sequelae of bleeding & thromboembolism:

    • Bleeding: intracranial, thorax, abdomen, cardiac tamponade

    • Thrombus: pulmonary embolism, acute renal failure, liver failure, stroke

 

 

Goals

 

  • Platelets: maintain above 50 000 (1 unit/10 kg; 0.1-0.2 units/kg)

  • Fresh frozen plasma: 10ml/kg to maintain INR < 1.5 – 2

  • Cryoprecipitate to maintain fibrinogen > 1.5 (2 units / 10 kg) (maintain > 2.0 in pregnant patients) 

  • pRBC’s to maintain organ perfusion

  • Follow coagulation profile, fibrinogen, hemoglobin & platelets at least hourly

  • Heparin not recommended (except possibly in DIC secondary to malignancies causing thrombosis)

  • Antifibrinolytics not recommended

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