title: Supportive management strategies for disseminated intravascular coagulation. An international consensus.
abstract: The cornerstone of the management of disseminated intravascular coagulation (DIC) is the treatment of the underlying condition triggering the coagulopathy. However, a number of uncertainties remain over the optimal supportive treatment. The aim of this study was to provide evidence and expert-based recommendations on the optimal supportive haemostatic and antithrombotic treatment strategies for patients with DIC. A working group defined five relevant clinical scenarios. Published studies were systematically searched in the MEDLINE and EMBASE databases (up to May 2014). Seven internationally recognised experts were asked to independently provide clinical advice. A two-phase blinded data collection technique was used to reach consensus. Only three randomised controlled trials (RCTs) on the supportive management of DIC were identified. The RCTs (overall less than 100 patients) investigated the use of fresh frozen plasma and platelet transfusion and found no differences in survival between the intervention and control groups. The experts' approach was heterogeneous, although there was consensus that supportive management should vary according to the underlying cause, clinical manifestations and severity of blood test abnormalities. Platelet transfusion should be given to maintain platelet count > 50×10⁹/l in case of bleeding while a lower threshold of 20 to 30×10⁹/l may be used in DIC without bleeding. Thromboprophylaxis with low-molecular-weight heparin is advised until bleeding ensues or platelet count drops below 30×10⁹/l. In conclusion, in the absence of solid evidence from RCTs, an individualised supportive management of DIC is advisable based on the type of underlying disease, presence of bleeding or thrombotic complications and laboratory tests results.
authors.affiliation: Alessandro Squizzato, U. O. C. Medicina I, Ospedale di Circolo, Viale Borri 57, 21100 Varese, Italy, Tel.: +39 0332 278831, E-mail: alexsquizzo@libero.it, alessandro.squizzato@uninsubria.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Squizzato
authors.forename: Beverley J
authors.initials: BJ
authors.lastname: Hunt
authors.forename: Gary T
authors.initials: GT
authors.lastname: Kinasewitz
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.forename: Hugo
authors.initials: H
authors.lastname: Ten Cate
authors.forename: Jecko
authors.initials: J
authors.lastname: Thachil
authors.forename: Marcel
authors.initials: M
authors.lastname: Levi
authors.forename: Vicente
authors.initials: V
authors.lastname: Vicente
authors.forename: Armando
authors.initials: A
authors.lastname: D'Angelo
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
mesh_terms: D004211:Disseminated Intravascular Coagulation / Q000097:blood / Q000209:etiology / Q000628:therapy*; D005104:Expert Testimony; D006470:Hemorrhage / Q000628:therapy; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007558:Italy; D010949:Plasma; D017713:Platelet Transfusion; D011655:Pulmonary Embolism / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D012955:Societies, Medical; D054556:Venous Thromboembolism / Q000628:therapy; D020246:Venous Thrombosis / Q000628:therapy
chemical_list: D006495:Heparin, Low-Molecular-Weight
keywords: Disseminated intravascular coagulation (DIC); fresh frozen plasma; platelet transfusion; prophylaxis; venous thrombosis