Disseminated intravascular coagulation (DIC) is an acquired syndrome of intravascular coagulation and is commonly encountered in critically ill patients.
Think about DIC in the critically ill patient with oozing at vascular sites (or wounds) and the following lab abnormalities:
Thrombocytopenia
Prolonged PT and aPTT
Decreased fibrinogen
Elevated fibrin split products and D-dimer
Guidelines for the management of DIC are primarily based on expert opinion and include:
Treat the underlying condition (i.e., sepsis)
Transfuse platelets if < 50,000 per mm3
Transfuse FFP to maintain PT and aPTT < 1.5 times normal control
Transfuse cryoprecipitate to maintain fibrinogen levels > 1.5 g/L
The use of heparin remains controversial and cannot be routinely recommended.
References
Hunt B. Bleeding and coagulopathies in critical care. NEJM 2014;370:847-59.
