Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

low bleeding risk

1st line – treatment of the underlying disorder

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ACUTE
|
low bleeding risk
1st line – 

treatment of the underlying disorder

Active treatment of the underlying disorder to remove the triggering factor is the most effective management approach, and should be applied to all patients.

Risk assessment for DIC may be used as a surrogate measure of bleeding risk. Global coagulation tests should be ordered: platelet count; D-dimer/fibrin degradation products; prothrombin time; and fibrinogen. A specific score, reflecting the severity of abnormality, is given to each of the tests.

A total score ≥5 is compatible with overt DIC. Daily repeat scoring is recommended.

A score <5 suggests non-overt DIC, and the tests should be repeated in the next 1 to 2 days.

high bleeding risk or active bleeding

1st line – treatment of the underlying disorder

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ACUTE
|
high bleeding risk or active bleeding
1st line – 

treatment of the underlying disorder

Active treatment of the underlying disorder to remove the triggering factor is the most effective management approach, and should be applied to all patients.

A patient with DIC is considered at high risk of bleeding if: a general risk for bleeding is found; the patient is about to undergo an invasive procedure; or there is documented deficiency of platelets and/or coagulation factors.

Risk assessment for DIC may be used as a surrogate measure of bleeding risk. Global coagulation tests should be ordered: platelet count; D-dimer/fibrin degradation products; prothrombin time; and fibrinogen. A specific score, reflecting the severity of abnormality, is given to each of the tests.

A total score ≥5 is compatible with overt DIC. Daily repeat scoring is recommended.

A score <5 suggests non-overt DIC, and the tests should be repeated in the next 1 to 2 days.

Plus – platelets + coagulation factors and coagulation inhibitors

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ACUTE
|
high bleeding risk or active bleeding
Plus – 

platelets + coagulation factors and coagulation inhibitors

Treatment recommended for ALL patients in selected patient group

A platelet transfusion should be considered when the platelet count is <20 x 10⁹/L (<20 x 10³/microlitre) or <50 x 10⁹/L (<50 x 10³/microlitre) with active bleeding.[10]

Fresh frozen plasma (FFP) is the preferred agent for replacement of coagulation factors and coagulation inhibitors when significant bleeding is present or when fibrinogen levels are <2.94 micromol/L (<100 mg/dL).[2] Cryoprecipitates or fibrinogen concentrates are second-line alternatives.

Blood-borne diseases of all types (hepatitis, HIV) and febrile reactions are always a risk in giving human blood products.

Rapid infusion of platelets, FFP, cryoprecipitates, or fibrinogen concentrates may cause hypotension.

ONGOING

chronic DIC

1st line – treatment of the underlying disorder

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ONGOING
|
chronic DIC
1st line – 

treatment of the underlying disorder

Active treatment of the underlying disorder to remove the triggering factor is the most effective management approach, and should be applied to all patients.

Consider – heparin

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ONGOING
|
chronic DIC
|
dominant thrombotic signs
Consider – 

heparin

Additional treatment recommended for SOME patients in selected patient group

Heparin may be indicated in selected patients with dominant symptoms and signs of thrombosis without evidence of significant bleeding, especially in the case of chronic DIC.[2][7][10]

Heparin use is not advocated in patients at high risk of bleeding because it may worsen the bleeding problems associated with DIC.[7]

Heparin therapy augments antithrombin III activity and inhibits conversion of fibrinogen to fibrin.

Primary options

heparin: consult specialist for guidance on dose

Consider – antifibrinolytic agents

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ONGOING
|
chronic DIC
|
with underlying hyperfibrinolysis
Consider – 

antifibrinolytic agents

Additional treatment recommended for SOME patients in selected patient group

Hyperfibrinolysis can occur with acute promyelocytic leukemia and other forms of cancer. Antifibrinolytic agents, such as aminocaproic acid and tranexamic acid, should be use with extreme caution because they inhibit the fibrinolytic pathways, which may worsen the symptoms and signs of thrombosis. They are occasionally used in patients with severe refractory bleeding resistant to conventional replacement therapy or in patients with hyperfibrinolysis associated with acute promyelocytic leukemia and other forms of cancer.[1][2]​​[10][17]

Tranexamic acid can be used as an alternative to aminocaproic acid. Neither drug is approved for use in DIC; therefore, consultant guidance should always be sought before using antifibrinolytic agents.

Primary options

aminocaproic acid: consult specialist for guidance on dose

OR

tranexamic acid: consult specialist for guidance on dose

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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