Abstract
Background
The diagnosis and treatment of disseminated intravascular coagulation (DIC) remain
extremely controversial.
Purpose
The Italian Society for Thrombosis and Haemostasis commissioned a project to develop
clinical practice guidelines for the diagnosis and treatment of DIC.
Methods
Key questions about the diagnosis and treatment of DIC were formulated by a multidisciplinary
working group consisting of experts in clinical medicine and research. After a systematic
review and discussion of the literature, recommendations were formulated and graded
according to the supporting evidence. In the absence of evidence, evidence of low
quality, or contradictory evidence, a formal consensus method was used to issue clinical
recommendations.
Results and Conclusions
In suspected DIC, we suggest the use of the diagnostic scores ISTH (grade C), JMHW
(grade C) or JAAM (grade D) over stand alone tests. The cornerstone of the management
of DIC remains the treatment of the underlying triggering disease. We do not suggest
the use of antithrombin (grade D), dermatan sulphate (grade D), gabexate (grade D),
recombinant factor VIIa (grade D), activated protein C (grade D), thrombomodulin (grade
B). The use of unfractionated heparin or low-molecular-weight heparin is not suggested
except for thromboembombolic prophylaxis in patients a high risk who do not have active
bleeding (grade D). In patients with severe sepsis/septic shock and DIC we suggest
the use of human recombinant activated protein C (grade D). In patients with DIC and
active bleeding we suggest the use of transfusion therapy (platelets, plasma, cryoprecipitate)
(grade D).
Abbreviations:
APACHE (Acute Physiology and Chronic Health Evaluation), DIC (Disseminated intravascular coagulation), FDP (fibrin degradation products), FFP (fresh-frozen plasma), ISTH (International Society on Thrombosis and Hemostasis), JAAM (Japanese Association for Acute Medicine), JMHW (Japanese Ministry of Health and Welfare), LMWH (low-molecular-weight heparin), PT (prothrombin time), RCT (randomized clinical trial), rFVIIa (recombinant activated factor VII), rhAPC (recombinant human activated protein C), SIGN (Scottish Intercollegiate Guideline Network), SISET (Società Italiana per lo Studio dell'Emostasi e Trombosi/Italian Society for Thrombosis and Haemostasis), UFH (unfractionated heparin)Keywords
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Article info
Publication history
Published online: September 19, 2011
Accepted:
August 28,
2011
Received in revised form:
August 21,
2011
Received:
July 8,
2011
Footnotes
☆SISET: Società Italiana per lo Studio dell'Emostasi e Trombosi.
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
