eMedicine Specialties > Emergency Medicine > Hematology & Oncology

Disseminated Intravascular Coagulation: Follow-up

Author: Joseph U Becker, MD, Fellow, Global Health and International Emergency Medicine, Stanford University
Coauthor(s): Charles R Wira, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale School of Medicine
Contributor Information and Disclosures

Updated: Sep 10, 2009

Follow-up

Further Inpatient Care

  • Most patients with acute disseminated intravascular coagulation (DIC) require critical care treatment appropriate for the primary diagnosis, occasionally including emergent surgery.
  • Assessment of severity of DIC (DIC score)
    • A DIC scoring system has been proposed by Bick to assess the severity of the coagulopathy as well as the effectiveness of therapeutic modalities.50
    • Clinical and laboratory parameters are measured with regularity (every 8 h).

Further Outpatient Care

  • Patients who recover from acute DIC should follow up with their primary care provider or a hematologist.
  • Patients with low-grade or chronic DIC may be treated by a hematologist on an outpatient basis after initial assessment and stabilization.

Inpatient & Outpatient Medications

  • Outpatient medications may include antiplatelet agents for those with low-grade DIC and/or antibiotics appropriate to the primary diagnosis. 
  • DIC can result from several clinical conditions including sepsis, trauma, obstetric emergencies, and malignancy. 
    • DIC results in intravascular coagulation mediated largely by exposure of blood to tissue factor via damage to the endothelium or by the expression of procoagulants by endothelial, malignant, and inflammatory cells. Ongoing coagulation in acute DIC quickly consumes coagulation factors and platelets producing a microangiopathic picture with simultaneous intravascular coagulation and hemorrhage. 
    • Diagnosis can be difficult, especially in cases of chronic, smoldering DIC, where clinical and laboratory abnormalities may be subtle. Treatment should primarily focus on addressing the underlying disorder. Platelet and factor replacement should be directed not at correcting laboratory abnormalities but to clinically relevant bleeding or procedural needs. Heparin should be provided to those patients who demonstrate extensive fibrin deposition without evidence of substantial hemorrhage and is usually reserved for cases of chronic DIC. Subgroups of patients with sepsis who have DIC may benefit from activated protein C (APC), with consideration given to its anticoagulant effects. Recognition of the importance of inflammation in sepsis, coagulation, and DIC is vitally important in directing the development of novel therapeutic strategies.

Transfer

  • Patients who are stable enough for transfer should be referred expeditiously to centers with appropriate critical care and subspecialty expertise, such as hematology, blood bank, or surgical centers.

Complications

  • Acute renal failure
  • Life-threatening thrombosis and hemorrhage (in patients with moderately severe–to–severe DIC)
  • Cardiac tamponade
  • Hemothorax
  • Intracerebral hematoma
  • Gangrene and loss of digits
  • Death

Prognosis

  • The prognosis is influenced most by the underlying condition that led to DIC and the severity of the DIC.

Miscellaneous

Medicolegal Pitfalls

  • Failure to establish early clinical suspicion and make a laboratory diagnosis, because the sequelae of DIC can be devastating
  • Failure to focus on treating the underlying cause of DIC when the thromboembolic and bleeding complications of the process seem to be dominating the clinical picture
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Mary A Furlong, MD, and Brendan R Furlong, MD, to the development and writing of this article.



More on Disseminated Intravascular Coagulation

Overview: Disseminated Intravascular Coagulation
Differential Diagnoses & Workup: Disseminated Intravascular Coagulation
Treatment & Medication: Disseminated Intravascular Coagulation
Follow-up: Disseminated Intravascular Coagulation
References
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Further Reading

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Contributor Information and Disclosures

Author

Joseph U Becker, MD, Fellow, Global Health and International Emergency Medicine, Stanford University
Joseph U Becker, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Charles R Wira, MD, Assistant Professor, Department of Surgery, Section of Emergency Medicine, Yale School of Medicine
Charles R Wira, MD is a member of the following medical societies: American College of Emergency Physicians, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

Steven A Conrad, MD, PhD, Chief, Department of Emergency Medicine; Chief, Multidisciplinary Critical Care Service, Professor, Department of Emergency and Internal Medicine, Louisiana State University Health Sciences Center
Steven A Conrad, MD, PhD is a member of the following medical societies: American College of Chest Physicians, American College of Critical Care Medicine, American College of Emergency Physicians, American College of Physicians, International Society for Heart and Lung Transplantation, Louisiana State Medical Society, Shock Society, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Jeffrey L Arnold, MD, FACEP, Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center
Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP, Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, University Hospitals, Case Medical Center
Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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