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[Treatment of disseminated intravascular coagulation]
1Third Department of Internal Medicine (III) Kanazawa University School of Medicine.
Insights
Early diagnosis and prompt treatment are key for Disseminated Intravascular Coagulation (DIC). Anticoagulant therapies, including heparin and antithrombin-III, are vital, with antifibrinolytics useful in specific DIC cases.
Area of Science:
- Hematology
- Pharmacology
Context:
- Disseminated Intravascular Coagulation (DIC) is a complex hematological disorder.
- Effective management requires timely diagnosis and intervention.
Purpose:
- To review current therapeutic strategies for DIC.
- To highlight the importance of anticoagulant agents and their classification.
- To discuss the potential role of antifibrinolytic and antiplatelet agents in selected DIC cases.
Summary:
- Successful DIC therapy hinges on early diagnosis and treating the underlying cause.
- Anticoagulant agents, classified by their mechanism (antithrombin, anti-Xa, or combined), are crucial.
- Available drugs include heparin, antithrombin-III concentrate, gabexate mesilate, nafamostat mesilate, MD-805, low molecular weight heparin, heparan sulfate, and activated protein C, all showing efficacy.
- Antifibrinolytic agents may benefit selected DIC cases with hyperfibrinolysis, such as acute promyelocytic leukemia.
- Antiplatelet agents might be indicated for certain chronic DIC presentations.
Impact:
- Provides a comprehensive overview of DIC treatment options.
- Informs clinical decision-making regarding anticoagulant and other therapies.
- Suggests tailored approaches for specific DIC subtypes, improving patient outcomes.
Abstract:
Early diagnosis and immediate treatment of the disease responsible for DIC are most important for successful therapy of DIC. Furthermore, it is also necessary to use anticoagulant agents in most cases of DIC. The agents may be classified on the basis of their mode of anticoagulant action into three groups: ones with antithrombin effect, ones with anti-Xa effect or ones with both effect, and each agent is hoped to be chosen appropriately for development of DIC in near future. At present, such anticoagulant agents as standard heparin, antithrombin-III concentrate, gabexate mesilate, nafamostat mesilate, MD-805, low molecular weight heparin, heparan sulfate, activated protein C, are known as drugs for DIC, and each of them was effective for improvement from DIC in our experience. Antifibrinolytic agents, which have been considered to be contraindicated for therapy of DIC, may be good indication for selected cases of DIC with enhanced fibrinolysis such cases as acute promyelocytic leukemia. Antiplatelet agents may be available for some cases of chronic DIC.