title: Management of disseminated intravascular coagulation: a survey of the International Society on Thrombosis and Haemostasis.
abstract: BACKGROUND
  It is not clear if and how international guidelines on the management of disseminated intravascular coagulation (DIC) are translated in routine clinical practice.
  
  
  METHODS
  A survey was conducted among different specialists who treat DIC. The survey examined six hypothetical case scenarios including the diagnosis of DIC, the treatment of non-overt and overt DIC with or without thrombosis, and the management of DIC patients at risk of bleeding or actively bleeding.
  
  
  RESULTS
  There were 191 respondents and 73 returned complete questionnaires. Most of respondents were specialists in hematology (48%) or intensive care (30%). In suspected overt or non-overt DIC, only one third use formal diagnostic scores while two thirds rely on a broad panel of coagulation tests independently of any score. In non-overt DIC, 68% provide no treatment, but monitor laboratory tests. Monitoring was considered by 48% of respondents in overt DIC without thrombosis or bleeding. When a thrombotic or bleeding complication ensues, 29% consider intervening only if the event is major. In DIC patients judged at risk of bleeding, 67% use prophylactic transfusions, mostly fresh-frozen plasma (73%) and platelets (65%). Active bleeding is often managed with fresh-frozen plasma (83%) and platelet transfusions (68%) as first line and recombinant activated factor VII (31%) as second line treatment.
  
  
  CONCLUSIONS
  This survey shows a largely heterogeneous approach of clinicians to the diagnosis and management of DIC. There is limited use of diagnostic scores despite guidelines' recommendations. The prevalent attitude seems monitoring DIC and limiting treatment to the underlying disease, unless thrombosis or bleeding develop, but modalities varied considerably.
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, Chieti, Italy; Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: mdinisio@unich.it.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.affiliation: Department of Haematology, Manchester Royal Infirmary, Oxford road, Manchester, United Kingdom, M13 9WL. Electronic address: Jecko.Thachil@cmft.nhs.uk.
authors.forename: Jecko
authors.initials: J
authors.lastname: Thachil
authors.affiliation: Research Center on Thromboembolic Disorders and Antithrombotic Therapies, Department of Clinical and Experimental Medicine, University of Insubria, Varese, Italy. Electronic address: alexsquizzo@libero.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Squizzato
mesh_terms: D004211:Disseminated Intravascular Coagulation / Q000097:blood*; D006487:Hemostasis / Q000187:drug effects*; D006801:Humans; D011795:Surveys and Questionnaires; D013927:Thrombosis / Q000188:drug therapy*
keywords: Arterial thrombosis; Disseminated intravascular coagulation; Management; Venous thrombosis