Diagnosis and management of disseminated intravascular coagulation

Disseminated intravascular coagulation (defibrination syndrome, consumption coagulopathy) is a syndrome which may complicate a number of pathologic states. If clotting factors and platelets are "consumed" more rapidly than the patient can produce them, they may fall to levels which are not adequate for hemostasis. Thus, thrombosis with resulting necrosis and hemorrhage may occur simultaneously in the same patient. Local fibrinolysis (secondary fibrinolysis) may remove or partially remove intravascular thrombi, thus protecting against local tissue necrosis. Diagnosis of the fulminating syndrome is usually simple and depends upon a few relatively easy tests. If the syndrome is low grade, diagnosis is very difficult and may be impossible without sophisticated techniques. Differential diagnosis from coagulation defects secondary to liver disease is extremely difficult. Treatment in the fulminating case before intravascular thrombi can cause irreversible tissue damage is urgent. Treatment depends upon therapy of the underlying disease plus adequate heparinization. It may be necessary to administer platelets and blood fractions after heparinization. Corticosteroids are not contraindicated, particularly when the patient is heparinized. Epsilon-amino-caproic acid (EACA, Amicar) is contraindicated. This drug inhibits local fibrinolysis, which is protective to the patient.