DIC with Active Bleeding or at High Risk of Bleeding: Management Approach
Patients with disseminated intravascular coagulation (DIC) who are actively bleeding, or who are at elevated bleeding risk — including those in the postoperative setting or scheduled for an invasive procedure — require a specific, carefully considered haemostatic approach.
Clinical scenario
In this population, transfusion of platelets or plasma components should not be driven primarily by laboratory results alone — it is generally reserved for patients presenting with bleeding. When the platelet count falls below 50 × 10&sup9;/l in patients with DIC who are bleeding or at high bleeding risk (such as postoperative patients or those about to undergo an invasive procedure), platelet transfusion should be considered.
Treatment overview
When plasma-based replacement is not feasible — for example in the setting of fluid overload — specific factor concentrate options form part of the haemostatic approach. The protocol also addresses what to consider when severe hypofibrinogenaemia persists despite standard replacement therapy.
Full selection criteria, options, and clinical considerations available in the complete protocol.
References
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 × 10&sup9;/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).
View source ↗