Dipyridamole and low doses of heparin as a new successful physiopathologic and therapeutic approach in 2 cases of disseminated intravascular coagulation.
OPERATIVE: We report 2 cases of disseminated intravascular coagulation (DIC) successfully treated with the combination of the platelet adhesiveness blocker dipyridamole and low doses of intravenous heparin.


METHODS
The first patient was a 17-year-old boy with septic arthritis; the second patient was a 12-year-old boy with a liver abscess. Both had hemocultures positive for Staphylococcus aureus. The diagnosis of DIC was defined by clinical signs of septicemia with fever, tachypnea, peripheral vasoconstriction, and low platelet counts (67,000/mm3 and 47,000/mm3, respectively). The second patient also presented with acute ischemia of the fingers and toes. General care was provided in the intensive care unit, and high doses of antibiotics were provided continuously (metronidazole and oxacillin or ceftriaxone). A 5% glucose solution containing dipyridamole (Persantine; Istituto De Angeli/Boheringer Ingelheim, Reggello, Italy) was administered by continuous intravenous infusion (20 mg/24 hours). In addition, regular heparin (Liquemin; Roche, Indianapolis, IN, USA) was administered at a dosage of 250 microg/kg per hour or 25 IU/kg per hour (6 mg/kg per 24 hours). These heparin doses are not able to promote complete blood anticoagulation. Treatment with heparin and dipyridamole was maintained for 10 days in the first patient and for 18 days in the second.


RESULTS
By 48 hours after treatment with dipyridamole and low-dose heparin, both patients recovered and presented with a good clinical condition and increased numbers of circulating platelets. Both patients were discharged in a safe clinical condition in the second month after hospital admission.


CONCLUSIONS
Successful clinical recovery of 2 young patients with DIC with an unfavorable clinical evolution and a prognosis for a lethal outcome was achieved with the combination of a continuous infusion of dipyridamole and low doses of heparin.
Gomes
Otoni M
OM
São Francisco de Assis Truth is Jesus Cardiovascular Foundation, Belo Horizonte, Brazil. gomes@servcor.com
Gomes
Eros S
ES
D000293:Adolescent; D000925:Anticoagulants / Q000008:administration & dosage; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000188:drug therapy*; D002648:Child; D004176:Dipyridamole / Q000008:administration & dosage*; D004338:Drug Combinations; D006493:Heparin / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome
D000925:Anticoagulants; D004338:Drug Combinations; D010975:Platelet Aggregation Inhibitors; D004176:Dipyridamole; D006493:Heparin