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Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines
Hideo Wada1, Takeshi Matsumoto2, Yoshiki Yamashita3
1Department of Molecular and Laboratory Medicine, Mie University School of Medicine, 2-174 Edobashi, Tsu, Mie, 514-8507 Japan.
Insights
Disseminated intravascular coagulation (DIC) is classified into four types. The International Society of Thrombosis and Hemostasis (ISTH) harmonized guidelines for diagnosing and treating these DIC types.
Area of Science:
- Hematology
- Internal Medicine
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) presents diverse clinical manifestations, including bleeding, organ failure, and asymptomatic presentations.
- Existing guidelines from various hematology societies showed discrepancies in DIC diagnosis and management.
- Harmonization efforts were needed to standardize DIC care globally.
Purpose of the Study:
- To present the harmonized guidelines for the diagnosis and treatment of Disseminated Intravascular Coagulation (DIC) by the International Society of Thrombosis and Hemostasis (ISTH).
- To outline the different diagnostic criteria and recommended treatments based on DIC type.
Main Methods:
- Review and synthesis of existing guidelines from the British Committee for Standards in Haematology, Japanese Society of Thrombosis and Hemostasis, and Italian Society for Thrombosis and Haemostasis.
- Development of harmonized diagnostic criteria and treatment recommendations by the ISTH.
Main Results:
- Four categories of DIC are recognized: bleeding, organ failure, massive bleeding, and non-symptomatic.
- Diagnostic criteria vary, with some applicable to bleeding/massive bleeding types and others to organ failure/massive bleeding types.
- Treatment strategies differ by DIC type, involving addressing underlying conditions, blood transfusions, heparin, protease inhibitors, and antifibrinolytic therapy.
Conclusions:
- The ISTH has established harmonized guidelines for DIC diagnosis and treatment, addressing previous discrepancies.
- Tailoring diagnostic approaches and therapeutic interventions to specific DIC types is crucial for optimal patient outcomes.
- Adherence to these standardized guidelines will improve the management of patients with Disseminated Intravascular Coagulation.
Abstract:
Disseminated intravascular coagulation (DIC) is categorized into bleeding, organ failure, massive bleeding, and non-symptomatic types according to the sum of vectors for hypercoagulation and hyperfibrinolysis. The British Committee for Standards in Haematology, Japanese Society of Thrombosis and Hemostasis, and the Italian Society for Thrombosis and Haemostasis published separate guidelines for DIC; however, there are several differences between these three sets of guidelines. Therefore, the International Society of Thrombosis and Haemostasis (ISTH) recently harmonized these differences and published the guidance of diagnosis and treatment for DIC. There are three different diagnostic criteria according to the Japanese Ministry Health, Labour and Welfare, ISTH, and Japanese Association of Acute Medicine. The first and second criteria can be used to diagnose the bleeding or massive bleeding types of DIC, while the third criteria cover organ failure and the massive bleeding type of DIC. Treatment of underlying conditions is recommended in three types of DIC, with the exception of massive bleeding. Blood transfusions are recommended in patients with the bleeding and massive bleeding types of DIC. Meanwhile, treatment with heparin is recommended in those with the non-symptomatic type of DIC. The administration of synthetic protease inhibitors and antifibrinolytic therapy is recommended in patients with the bleeding and massive bleeding types of DIC. Furthermore, the administration of natural protease inhibitors is recommended in patients with the organ failure type of DIC, while antifibrinolytic treatment is not. The diagnosis and treatment of DIC should be carried out in accordance with the type of DIC.
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