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Author: Vanessa Ngan, Staff Writer, 2005.
Disseminated intravascular coagulation (DIC) presents in a very ill patient as bleeding into the skin (purpura) and other tissues. It arises as a complication of different serious and life-threatening diseases. It covers the continuum of events that occur in the coagulation pathway. Initially, there is uncontrolled activation of clotting factors in the blood vessels, causing clotting of blood throughout the whole body. This depletes the body of its platelets and coagulation factors and results in a paradoxically increased risk of bleeding (haemorrhaging).
Hence, patients with DIC have a loss of balance between the clot-forming activity of thrombin (an enzyme that causes blood to clot) and the clot-lysing activity of plasmin (an enzyme that dissolves blood clots). DIC is not a specific diagnosis and its presence always indicates another underlying disease.
There are two clinical forms of DIC, acute DIC and chronic DIC.
Acute DIC is a bleeding disorder caused by a number of conditions.
Chronic DIC is a thromboembolic disorder that is usually associated with:
|Acute DIC||Chronic DIC|
Identifying and treating the underlying disease is the mainstay of management for both acute and chronic DIC. Specific treatment of DIC may or may not be required depending on the signs and symptoms present.
|Treatment of acute DIC|
|Without bleeding or evidence of ischaemia||No treatment required, observe|
|With bleeding||Blood components:
|With ischaemia||Anticoagulants such as heparin or low molecular weight heparin (LMWH) after bleeding is corrected with blood products|
|Treatment of chronic DIC|
|Without thromboembolism||No specific therapy but prophylactic anticoagulants (e.g. low-dose heparin, LMWH) may be used for patients at high risk of thrombosis|
|With thromboembolism||Anticoagulant therapy with heparin or LMWH
A trial of warfarin (variable response between patients)
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