Management of Disseminated Intravascular Coagulation (DIC)

General Principles for DIC Management

The cornerstone of DIC management is treating the underlying condition (e.g., cancer, sepsis, trauma) 3, 1
Regular clinical and laboratory surveillance is essential to monitor disease progression and treatment response 2
Prophylactic anticoagulation is recommended in most patients with cancer-related DIC (except hyperfibrinolytic DIC) in the absence of contraindications 1
Therapeutic-dose anticoagulation should be used in patients who develop arterial or venous thrombosis 4

Routine use of tranexamic acid in DIC is strongly discouraged due to increased thrombotic risks 1, 5
Non-hyperfibrinolytic forms of DIC should not be treated with tranexamic acid as it may worsen outcomes 2, 6
Tranexamic acid may be considered only in hyperfibrinolytic DIC when therapy-resistant bleeding dominates the clinical picture 1, 2
APTEM testing (thromboelastometric monitoring) should be used to confirm hyperfibrinolysis before administering tranexamic acid 6
The recommended dosing in such cases is 10-15 mg/kg loading dose followed by 1-5 mg/kg/hour infusion 6
The International Society on Thrombosis and Haemostasis (ISTH) guidelines recommend against routine use of tranexamic acid in DIC 1, 2