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Coagulopathies in Critical Illness - DIC
- 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.