This protocol addresses disseminated intravascular coagulation in patients who are actively bleeding or face a high bleeding risk — including those in the postoperative setting or scheduled to undergo an invasive procedure.
In this clinical scenario, component transfusion decisions should be driven by the patient's bleeding status rather than laboratory findings alone. Platelet transfusion is considered when counts are critically low in patients who are bleeding or at elevated procedural risk.
The approach accounts for the constraints of each patient's clinical situation, including volume status and the nature and severity of the coagulopathy.
When standard plasma-based volume replacement cannot be used due to fluid overload, targeted coagulation factor support with concentrate preparations may be considered as an alternative. Additional replacement strategies address persistent severe deficiencies in specific clotting proteins when first-line measures are insufficient — the complete algorithm, agent selection, and sequencing are available in the full structured protocol.
DOI: 10.1111/j.1365-2141.2009.07600.x
Transfusion of platelets or plasma (components) in patients with DIC should not primarily be based on laboratory results and should in general be reserved for patients that present with bleeding (Grade C, Level IV).
In patients with DIC and bleeding or at high risk of bleeding (e.g. postoperative patients or patients due to undergo an invasive procedure) and a platelet count of <50 × 10⁹/l, transfusion of platelets should be considered (Grade C, Level IV).
If transfusion of FFP is not possible in patients with bleeding because of fluid overload, consider using factor concentrates such as prothrombin complex concentrate, recognising that these will only partially correct the defect because they contain only selected factors, whereas in DIC there is a global deficiency of coagulation factors (Grade C, Level IV).
Severe hypofibrinogenaemia (<1 g/l) that persists despite FFP replacement may be treated with fibrinogen concentrate or cryoprecipitate (Grade C, Level IV).
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