Treatment Desired Outcomes

The cornerstone of the management of DIC is aggressive treatment of the underlying primary illness. Supportive measures may be used as necessary, but owing to the heterogeneity of DIC etiology, treatment should be guided by predominant symptoms

(bleeding or clotting). Goals of DIC treatment include:

• Replace missing blood components

• Interrupt coagulation

• Treat underlying disease

Pharmacologic Therapy Anticoagulants

While bleeding is the most frequently observed symptom of DIC, thrombotic events cause most of the mortality. Heparin is an effective anticoagulant which activates the antithrombin system and inhibits factors II (thrombin), IXa, and Xa; however, its use is limited by the potential for bleeding. Clinical trials of heparin in DIC have not shown a consistent improvement in organ function or mortality benefit. DIC patients most likely to benefit from heparin are those with chronic symptomatic thromboem-boli, extensive fibrin deposition, and solid tumors. Heparin is contraindicated in DIC

patients with serious or life-threatening bleeding, such as intracranial bleeding.

Table 67-8 Conditions Associated With DIC

ciidiiHiitiilii

At ute ntyotifdul inf arclïm AivjkiDt liy

Aortic arH:\jl ySJlfl

Aortic tulluOn JlSiar tie™.-!

toivi hemjngiorirw fletipheral vascular rh-vease

Pnpiihiiic deviez

Rayi\aud's syndrome lnf»(Hpus

AiDantuS

■AipenjuUtri

GumiyaölNfdiiti

CyiomiqÎliwirtii

Etc Id virus iyjim-nc^jiive tjitaij

Gram-poililvebacwila

Heipesviius

Htiltjptosmfl

Human immunodeficiency virus

InNuerua tbfa-m

Malrti

^rtJpfcrflTM

Paramyxoviruses

RubelLi

Typhoid

Viricellj

Variola

Inlrivisfu la; Hcmclirili

Hemolytic lr*nsfuHon nMtlio<h Himolytk ureirit syrxjiort^ Minor hemolysis Mj ys ivt.L 1 r a n i-1 u yijn

Nrwborn

Birth asphy* la Hypothermia

.Mi^oiiiiirn (X jimniotfc Ilukl JSpir Jtitfft hetiolldng cnlenocolills flrtuiiJKii y drilrttl iyiXiiûtW

dbuilria

AboUmn

Amniotic iluid flrtitoliSiti f al ty Iivlh of pregnancy S'ldt'.Tiljl atnuptfcjii l'recç lamps ¡S^ldim pi L> Retained fetus syndrome Pulmonary ImjJirtiïia

Hyalin? membrane disease i'ulnWiJiy tmbfüfcirt i'nliinyi.iiy mr.iri iDon Tissue Injury

Klfllfi

Crvîh 4Tfjurtiî Imenuyp surgery HHd trjurri.fc Multiple irs^mj

Mlscellineoui

AckJ-tuac imbalance Arme1 Ihn fjüde Am pt «Hammes AfuphytiniJ Awnimmune diiftwei ChctesLass

Chronic liHiarfiiiiiaKMydiicji« Collagen vascular disease ClvÙMriy

EHTMOipcMalcttulaüan Extracorporal irembiane o«yger>a1lon fat dUnOliSflil i te.Jl inctt

Hemarhagk lelarxjiet tasia riipiHi

Leukemia

Lighlning suites

U<Vsi diQwilifH)

Organ»; solvent pofcjnmg

Piioocyynjl notturnjl hemoglcij"iui-j l^iioncovprKXiSOi ptftii(wncv5 ihgntt

Polycythemia rubra vera flienal vase Jar diso rdeis

Neveii1 anoxia

^nafee bite

Wut tumors

Tiansfibnt rejection

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