title: Diagnosis and treatment of disseminated intravascular coagulation: guidelines of the Italian Society for Haemostasis and Thrombosis (SISET).
abstract: BACKGROUND
  The diagnosis and treatment of disseminated intravascular coagulation (DIC) remain extremely controversial.
  
  
  OBJECTIVE
  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.
  
  
  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).
authors.affiliation: Department of Medicine and Aging, Centre for Aging Sciences, CeSI, University GD'Annunzio Foundation, Chieti, Italy. mdinisio@unich.it
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.forename: Francesco
authors.initials: F
authors.lastname: Baudo
authors.forename: Benilde
authors.initials: B
authors.lastname: Cosmi
authors.forename: Armando
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Andrea
authors.initials: A
authors.lastname: De Gasperi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Malato
authors.forename: Mario
authors.initials: M
authors.lastname: Schiavoni
authors.forename: Alessandro
authors.initials: A
authors.lastname: Squizzato
mesh_terms: D006801:Humans; D007558:Italy; D009369:Neoplasms / Q000097:blood* / Q000473:pathology / Q000628:therapy*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*