• ISTH Criteria for DIC (2001)
  • Does patient have disorder associated with overt DIC? (if YES --> proceed)
    • Platelets > 100 = 0, 50-100=1, <50=2
    • FDPs (e.g. D-dimer): none=0, moderate=2, strong=3
    • Prolonged PT beyond baseline: <3sec=0, 3-6sec=1, >6sec=2
    • Fibrinogen: >100=0, <100=1
  • Chronic DIC:  evidence of fibrinolysis (e.g. elevated D-dimer) in the absence of another etiology w/ compatible underlying cause (often malignancy)
  
  

  Posted 03/14/17 09:33:44 AM by Matthew Cummings

• Rationale for of heparin products to treat DIC
  • Thrombosis (thrombin generation exceeding that of plasmin) --> excessive degradation of fibrin and markedly low fibrinogen --> inability to clot --> bleeding
    • Anti-coagulation --> reduce thrombotic burden --> reduce degradation of fibrin --> increase ability to clot
  • Antifibrinolytic agents (TXA/Amicar) --> usually contraindicated --> blockade of the fibrinolytic system may increase the risk of thrombotic complications (limb/organ ischemia)
  
  

  Posted 03/14/17 09:40:00 AM by Matthew Cummings

• For further reading...

  Bleeding and Coagulopathies in Critical Care (NEJM Review 2014)
  DIC Review (NEJM 1999)
  
  

  Posted 03/14/17 10:16:44 AM by Matthew Cummings

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