Management of Disseminated Intravascular Coagulation in Cardiac Surgery

Immediate Management Priorities

• The American College of Cardiology recommends identifying and treating the surgical trigger as the cornerstone of DIC management, taking precedence over all other interventions 1
• Cardiac surgery triggers for DIC include cardiopulmonary bypass-related activation 2, surgical bleeding requiring re-exploration 3, and postoperative infection/sepsis 3

Hemostatic Support for Active Bleeding

• The American Society of Hematology recommends maintaining platelets >50×10⁹/L in patients with active bleeding 1
• Platelet transfusion is considered in high-risk patients without active bleeding only if platelets <20×10⁹/L 3
• Fresh frozen plasma (FFP) is administered at 15-30 mL/kg in actively bleeding patients with prolonged PT/aPTT 1

Anticoagulation Strategy

• Unfractionated heparin (UFH) is preferred in cardiac surgery patients due to its short half-life and easy reversibility with protamine 4, 2
• Contraindications to heparin include active uncontrolled bleeding 4, platelet count <20×10⁹/L 4, 2, and hyperfibrinolytic DIC 4, 2

Special Considerations for Cardiac Surgery

• Serial monitoring of platelet count, PT/aPTT, fibrinogen, and D-dimer is essential, with frequency at least daily in acute DIC 1, 2
• Tranexamic acid may be considered in therapy-resistant bleeding despite other measures, but its use is not routine due to increased thrombotic risk 1, 4