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[Principles of the therapy for disseminated intravascular coagulation: current status and new trends]
1First Department of Internal Medicine, Niigata University School of Medicine.
Insights
This review covers current and emerging therapies for disseminated intravascular coagulation (DIC). Key strategies include treating underlying diseases, anticoagulation, and supportive care, emphasizing individualized patient management.
Area of Science:
- Hematology
- Critical Care Medicine
- Pharmacology
Context:
- Disseminated intravascular coagulation (DIC) is a complex acquired syndrome.
- DIC is characterized by widespread activation of coagulation, leading to both thrombosis and hemorrhage.
- Therapeutic approaches for DIC are multifaceted, addressing the underlying cause and hemostatic dysregulation.
Purpose:
- To review the current therapeutic strategies for disseminated intravascular coagulation (DIC).
- To highlight new trends and emerging treatments for DIC.
- To emphasize the importance of individualized patient management in DIC therapy.
Summary:
- Therapeutic strategies for DIC encompass eliminating underlying diseases, anticoagulant therapy, replacement therapy, and general supportive care.
- Eliminating the underlying disease is the most critical therapeutic modality.
- Current anticoagulants include unfractionated heparin and antithrombin III concentrate, with novel agents like low-molecular-weight heparin and activated protein C under investigation.
- Management must be tailored to individual patients due to variable clinical and laboratory manifestations.
Impact:
- Provides a comprehensive overview of DIC management, aiding clinicians in treatment decisions.
- Identifies promising new therapeutic agents for DIC, potentially improving patient outcomes.
- Underscores the need for personalized medicine in critical care settings for complex hematological disorders like DIC.
Abstract:
The current status and new trends of therapy for disseminated intravascular coagulation (DIC) are reviewed. The therapeutic strategies consist of elimination of the underlying diseases, anticoagulant therapy, replacement therapy and general supportive care. The approach to eliminate the underlying disease process represents the most important therapeutic modality. Most patients need anticoagulant therapy in conjunction with specific factor replacement. Unfractionated heparin, antithrombin III concentrate, gabaxate mesilate and nafamostat mesilate are currently used as anticoagulants. Low-molecular-weight heparin, heparinoid, activated protein C, argatroban, hirudin and thrombomodulin are under clinical or animal studies to evaluate their effectiveness in DIC. Clinical and laboratory manifestations are extremely variable among patients, depending in part on the underlying diseases. Management should be individualized for each patient.