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Expert consensus for the treatment of disseminated intravascular coagulation in Japan
Hideo Wada1, Hidesaku Asakura, Kohji Okamoto
1Department of Molecular and Laboratory Medicine, Mie University School of Medicine, 2-174, Edobashi, Tsu, Mie-ken 514-8507, Japan. wadahide@clin.medic.mie-u.ac.jp
Insights
This expert consensus outlines Japanese treatment guidelines for disseminated intravascular coagulation (DIC). Treatment strategies for DIC vary by type, including asymptomatic, bleeding, and organ failure, with specific drug recommendations for each.
Area of Science:
- Hematology
- Internal Medicine
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with varying clinical presentations.
- Effective management of DIC requires tailored therapeutic approaches based on disease type.
Purpose of the Study:
- To provide an expert consensus on the treatment of disseminated intravascular coagulation (DIC) in Japan.
- To classify DIC into distinct types and recommend specific treatments for each.
Main Methods:
- The report synthesizes findings from clinical trials and expert opinions.
- Treatment recommendations are categorized based on DIC classification: asymptomatic, marked bleeding, and organ failure types.
Main Results:
- For asymptomatic DIC, low molecular weight heparin (LMWH), synthetic protease inhibitor (SPI), and antithrombin (AT) are suggested.
- In marked bleeding DIC, LMWH, SPI, and AT are recommended, while SPI is preferred for severe bleeding.
- For organ failure type DIC, AT is recommended, and blood transfusions are crucial for life-threatening bleeding.
Conclusions:
- Treatment for DIC must be individualized according to its type.
- While some treatments show promise, high-quality evidence for effectiveness is often limited.
- Anticoagulant therapy, including LMWH, unfractionated heparin (UFH), and danaparoid sodium (DS), may be necessary for DIC associated with thrombosis.
Abstract:
The present report from The Japanese Society of Thrombosis and Hemostasis provides an expert consensus for the treatment of disseminated intravascular coagulation (DIC) in Japan. Disseminated intravascular coagulation (DIC) may be classified as follows: asymptomatic type, marked bleeding type, and organ failure type. Although treatment of DIC is important, adequate treatment differs according to type of DIC. In asymptomatic DIC, low molecular weight heparin (LMWH), synthetic protease inhibitor (SPI), and antithrombin (AT) are recommended, although these drugs have not yet been proved to have a high degree of effectiveness. Unfractionated heparin (UFH) and danaparoid sodium (DS) are sometimes administrated in this type, but their usefulness is not clear. In the marked bleeding type, LMWH, SPI, and AT are recommended although these drugs do not have high quality of evidence. LMWH, UFH, and DS are not recommended in case of life threatening bleeding. In case of severe bleeding, SPI is recommended since it does not cause a worsening of bleeding. Blood transfusions, such as fresh frozen plasma and platelet concentrate, are also required in cases of life threatening bleeding. In the organ failure type, including sepsis, AT has been recommended based on the findings of several clinical trials. DIC is frequently associated with thrombosis and may thus require strong anticoagulant therapy, such as LMWH, UFH, and DS.
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