Treatment of DIC When Thrombosis Predominates: Arterial or Venous Thromboembolism, Purpura Fulminans, or Vascular Skin Infarction

In disseminated intravascular coagulation, the clinical picture can be dominated either by bleeding or by thrombosis. When thrombosis predominates, the management priorities shift accordingly — and a distinct therapeutic approach is warranted.

Clinical scenario

This protocol covers patients with DIC in whom thrombotic manifestations are the primary concern. The relevant presentations are:

Arterial or venous thromboembolism
Severe purpura fulminans associated with acral ischaemia
Vascular skin infarction

Treatment approach — partial overview

When thrombosis predominates in DIC, anticoagulant therapy is considered central to management. The choice and delivery of heparin-based treatment is guided by the patient's concurrent risk profile, particularly any co-existing risk of bleeding.

The complete regimen, decision algorithm, and full clinical criteria are available in the structured evidence-based protocol below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/j.1365-2141.2009.07600.x

In cases of DIC where thrombosis predominates, such as arterial or venous thromboembolism, severe purpura fulminans associated with acral ischaemia or vascular skin infarction therapeutic doses of heparin should be considered.

In these patients where there is perceived to be a co-existing high risk of bleeding there may be benefits in using continuous infusion UFH due to its short half-life and reversibility.

Weight adjusted doses (e.g. 10 μg/kg/h) may be used without the intention of prolonging the aPTT ratio to 1·5–2·5 times the control.

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