Medication
Rationale: The client has signs and symptoms of disseminated intravascular coagulation (DIC). Low-molecular-weight heparin is used to interfere with the clotting cascade and reduce the consumption of clotting factors by uncontrolled thrombosis. Warfarin is not used to treat DIC. Dialysis and amputation are not indicated at this time.
Procedures
The cornerstone of supportive treatment of this coagulopathy is management of the underlying condition. Additionally, administration of heparin may be useful, and restoration of physiological anticoagulants has been suggested, but has not been proven successful in improving clinically relevant outcomes so far.
Nutrition
The keystone in the management of DIC is adequate treatment of the underlying disorder. If the condition causing the DIC is properly dealt with (in the example of the case with bile duct drainage and antibiotics), the coagulopathy will spontaneously resolve.
What is the treatment for disseminated intravascular coagulation (DIC)?
In patients with major bleeding or at risk for hemorrhagic complications, administration of platelet concentrates, plasma, or coagulation factor concentrates should be considered. A variety of disorders, including severe sepsis, systemic inflammatory conditions, trauma, and malignant disease, will lead to activation of the coagulation system.
What are the supportive treatments for coagulopathy?
What are the treatment options for coagulopathy of the diaphragm (DIC)?
When are coagulation factor concentrates indicated in the treatment of sepsis?
What is the best treatment for DIC?
What is the treatment for disseminated intravascular coagulation (DIC)?Plasma transfusions to reduce bleeding. Plasma transfusion replace blood clotting factors affected by DIC.Transfusions of red blood cells and/or platelets.Anti-coagulant medication (blood thinners) to prevent blood clotting.
Which therapy is appropriate for chronic disseminated intravascular coagulation DIC?
Enoxaparin has been used for treatment and prophylaxis of chronic DIC in specific clinical situations. In a multicenter, cooperative, double-blinded trial from Japan that compared dalteparin with unfractionated heparin, the former was associated with a decreased bleeding tendency and reduced organ failure.
What is the most important goal for the treatment of DIC?
The goals of pharmacotherapy in cases of disseminated intravascular coagulation (DIC) are to reduce morbidity and to prevent complications. Therapy should be based on etiology and aimed at eliminating the underlying disease.
Why do you give heparin for DIC?
Heparin, as an anticoagulant, which, not only inhibits the activation of the coagulation system, but is also an anti-inflammatory and immunomodulatory agent, has been widely used during DIC treatment and in the prevention and treatment of thrombotic diseases. It is easy to obtain and inexpensive.
Do you give platelets for DIC?
In non-bleeding patients with DIC, prophylactic platelet transfusion is not given unless it is perceived that there is a high risk of bleeding. In bleeding patients with DIC and prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), administration of fresh frozen plasma (FFP) may be useful.
When do you give Cryo in DIC?
Cryoprecipitate should be given when fibrinogen levels fall below 100 mg dl−1. Cryoprecipitate is also used for fibrinogen replacement in patients with dysfibrinogenemia, where fibrinogen is present but functionally defective. Cryoprecipitate was previously used for congenital hypofibrinogenemia.
What drug would the nurse administer for its antiplatelet effects?
Antiplatelet agent administration can be via oral, rectal, or intravenous routes. Oral medications include aspirin, clopidogrel, ticagrelor, cilostazol, and dipyridamole.
What are the abnormalities of the hemostatic system in patients with DIC?
Abnormalities of the hemostatic system in patients with DIC result from the sum of vectors for hypercoagulation and hyperfibrinolysis (Figure 1). When the vector for hyperfibrinolysis is remarkable and dominant, bleeding is the primary symptom; this type is called the bleeding type or hyperfibrinolysis predominance type of DIC. This form of DIC is often seen in patients with leukemia, such as acute promyelocytic leukemia (APL), obstetric diseases, or aortic aneurysms [2, 7]. On the other hand, when the vector for hypercoagulation is remarkable and dominant, organ failure is the main symptom; this type of DIC is called the organ failure type, hypercoagulation predominance type or hypofibrinolysis type of DIC. This form of DIC is often observed in patients with infection, particularly sepsis. An increase in the level of plasminogen activator inhibitor I (PAI-I) induced by markedly increased levels of cytokines [8, 9] and lipopolysaccharide (LPS) [2, 7] in the blood has been reported to a cause of hypofibrinolysis. Moreover, neutrophil extracellular traps (NETs) [10], which release DNA with histone, neutrophil elastase, and cathepsin G in order to trap and kill pathogens, are present in patients with sepsis. Histones promote the apoptosis of vascular endothelial cells and platelet aggregation [11], while neutrophil elastase and cathepsin G decompose tissue factor pathway inhibitor (TFPI) in order to promote thrombus formation [12]. Moreover, high mobility group box 1 (HMGB-1) [13] is emitted from injured and dead cells in order to enhance the inflammatory reaction.
What is global coagulation test?
Global coagulation tests provide important evidence regarding the degree of coagulation factor activation and consumption. Although the PT is prolonged in approximately 50% of patients with DIC at some point during their clinical course [21], abnormalities are often observed in patients with liver disease or vitamin K deficiency. A reduction in the platelet count or clear downward trend in subsequent measurements is a sensitive sign of DIC [3], although this pattern is also observed in patients with bone marrow disorders. A reduced fibrinogen level is a valuable indicator regarding a diagnosis of DIC due to leukemia or obstetric diseases; however, it is not observed in most septic DIC patients [3]. Elevated fibrin-related markers (FRMs), such as FDP [26], D-dimer [27], or soluble fibrin (SF), reflect fibrin formation. SF [28] assays offer theoretical advantages in detecting DIC, more closely reflecting the effects of thrombin on fibrinogen, although the half-life is short. It is important to consider that many conditions, such as trauma, recent surgery, bleeding, or venous thromboembolism (VTE), are associated with elevated FRMs. Reductions in the levels of natural anticoagulants, such as antithrombin (AT) and protein C, are common in patients with DIC. Although measuring the AT activity is useful for achieving the full efficacy of heparin [29], this parameter cannot be quickly and easily measured in all hospitals. These activities are correlated with the liver function and/or concentration of albumin. A reduced ADAMTS13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13) activity and elevated soluble thrombomodulin (TM), PAI-I, and von Willebrand factor propeptide levels are often observed in patients with DIC and have been shown to have prognostic significance [30–32]. The biphasic waveform of the activated partial thromboplastin time (APTT) has been shown to be associated with DIC and appears to have a positive predictive value for the disease [33, 34]. Although many attractive markers for DIC have been reported, no single marker can be used to diagnose DIC alone (Table 2). Therefore, the above four guidelines [3–6] recommend that DIC could not be diagnosed according to the level of a single marker but rather based on the combination of laboratory markers. Among the four types of DIC, PT, fibrinogen, and platelets are important parameters for diagnosing the massive bleeding type of DIC, while fibrinogen, FDP, and plasmin-plasmin inhibitor complex (PPIC) are important for detecting the bleeding type of DIC. Meanwhile, platelets, PT, and AT are important for diagnosing the organ failure type of DICand hemostatic molecular markers, such as SF and the thrombin-AT complex, are important for diagnosing the non-symptomatic type of DIC.
What are the laboratory parameters used to diagnose DIC?
Various underlying clinical conditions can have an effect on the laboratory parameters that are usually obtained to diagnose DIC, such as global coagulation tests, the platelet count, prothrombin time (PT), and the fibrinogen, fibrinogen, and fibrin degradation products (FDPs). In order to facilitate the diagnostic process for detecting DIC, the use of a scoring system is recommended by each of the four different guidelines [3–6]. Three different diagnostic criteria incorporating similar global coagulation tests have been established by the ISTH/SSC [1], Japanese Ministry Health, Labour and Welfare (JMHLW) [17], and Japanese Association of Acute Medicine (JAAM) [18]. The JMHLW score is well correlated with the severity of DIC and can be used to predict the outcome of the disease [14]. The ISTH overt DIC score is useful and specific for diagnosing DIC due to infective and non-infective etiologies [13, 19]. The JAAM score is sensitive for detecting septic DIC and is correlated with the ISTH and JMHLW scores and disease outcome [13, 18]. A prospective study in Japan reported no significant differences in the odds ratio for predicting DIC outcomes among these three diagnostic criteria [20], suggesting that the identification of molecular hemostatic markers and changes of global coagulation tests is required in addition to the application of scoring systems. The use of a combination of tests repeated over time in patients with suspected DIC can be used to diagnose the disorder with reasonable certainty in most cases [21–23]. A template for a non-overt-DIC scoring system, including global coagulation tests, changes in global coagulation tests as well as hemostatic molecular markers, has been proposed [1, 24, 25].
What is DIC in a patient?
Disseminated intravascular coagulation (DIC) is a syndrome characterized by the systemic activation of blood coagulation, which generates intravascular thrombin and fibrin, resulting in the thrombosis of small- to medium-sized vessels and ultimately organ dysfunction and severe bleeding [1, 2]. DIC may result as a complication of infection, solid cancers, hematological malignancies, obstetric diseases, trauma, aneurysms, and liver diseases, etc., each of which presents characteristic features related to the underlying disorder. The diagnosis and treatment of DIC must therefore consider these underlying etiological features. The type of DIC is related to the underlying disorder. Three guidelines for diagnosis and treatment of DIC [3–5] have been published in the literature by the British Committee for Standards in Haematology (BCSH), Japanese Society of Thrombosis and Hemostasis (JSTH), and Italian Society for Thrombosis and Haemostasis (SISET). Although these three guidelines are broadly similar, there are variations in several recommendations regarding DIC treatment. Therefore, the subcommittee for DIC of the Scientific and Standardization Committee (SSC)/International Society of Thrombosis and Haemostasis (ISTH) harmonized these three guidelines in a report entitled, Guidance for the diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines[6] (Table 1). The present review describes several recommendations for the diagnosis and treatment of DIC related to the type of DIC.
What is DIC in a hospital?
Disseminated intravascular coagulation (DIC) is categorized into bleeding, organ failure, massive bleeding, and non-symptomatic types according to the sum of vectors for hypercoagulation and hyperfibrinolysis. The British Committee for Standards in Haematology, Japanese Society of Thrombosis and Hemostasis, and the Italian Society for Thrombosis and Haemostasis published separate guidelines for DIC; however, there are several differences between these three sets of guidelines. Therefore, the International Society of Thrombosis and Haemostasis (ISTH) recently harmonized these differences and published the guidance of diagnosis and treatment for DIC. There are three different diagnostic criteria according to the Japanese Ministry Health, Labour and Welfare, ISTH, and Japanese Association of Acute Medicine. The first and second criteria can be used to diagnose the bleeding or massive bleeding types of DIC, while the third criteria cover organ failure and the massive bleeding type of DIC. Treatment of underlying conditions is recommended in three types of DIC, with the exception of massive bleeding. Blood transfusions are recommended in patients with the bleeding and massive bleeding types of DIC. Meanwhile, treatment with heparin is recommended in those with the non-symptomatic type of DIC. The administration of synthetic protease inhibitors and antifibrinolytic therapy is recommended in patients with the bleeding and massive bleeding types of DIC. Furthermore, the administration of natural protease inhibitors is recommended in patients with the organ failure type of DIC, while antifibrinolytic treatment is not. The diagnosis and treatment of DIC should be carried out in accordance with the type of DIC.
What is reduced fibrinogen level?
A reduced fibrinogen level is a valuable indicator regarding a diagnosis of DIC due to leukemia or obstetric diseases; however, it is not observed in most septic DIC patients [3]. Elevated fibrin-related markers (FRMs), such as FDP [26], D-dimer [27], or soluble fibrin (SF), reflect fibrin formation.
What is the name of the DIC that is caused by a large amount of blood?
When both vectors for hypercoagulation and hyperfibrinolysis are remarkable and strong, major bleeding occurs, followed by death, if a sufficient amount of blood is not transfused; this type of DIC is called the massive bleeding or consumptive type of DIC.
What is disseminated intravascular coagulation?
Disseminated intravascular coagulation is a rare and serious condition that can disrupt your blood flow. It is a blood clotting disorder that can turn into uncontrollable bleeding. DIC affects about 10% of all people who are very ill with sepsis, diseases such as cancer or pancreatitis, as well as people recovering from traumatic injuries such as burns or serious complications from pregnancy and delivery.
What is DIC in medical terms?
Disseminated intravascular coagulation (DIC) is a rare and serious condition that disrupts your blood flow. It is a blood clotting disorder that can turn into uncontrollable bleeding. DIC can affect people who have cancer or sepsis. It can also affect people recovering from complications from pregnancy and delivery or who have been injured.
What does it mean when you have DIC?
Most people who have DIC are already coping with illness or a medical condition. Being diagnosed with disseminated intravascular coagulation means you have another medical concern to manage as you continue the treatment and testing for the medical condition that caused your DIC. Here are some suggestions that might help:
What happens when you have DIC?
Then, having used up the proteins and platelets that make your blood clot, DIC might cause uncontrollable internal or external bleeding.
What is the most common cause of DIC?
Sepsis, which is wide-spread inflammation or swelling in your body. Sepsis is the most common cause of DIC.
What is a D-dimer?
D-dimer. This is a blood test to check for blood clots.
Can DIC cause bleeding?
Fortunately, early diagnosis and supportive treatment can help to stop the blood clotting or bleeding that DIC causes so that your healthcare providers can focus on treating your underlying illnesses or injuries.
What causes DIC in a patient?
Cancer is the most common cause of chronic DIC. Constipation and diminished bowel sounds are not generally associated with chronic DIC. The nurse is assessing a client suspected of having acute disseminated intravascular coagulation (DIC).
What is DIC in nursing?
Disseminated intravascular coagulation ( DIC) is triggered by an injury or agent that activates the clotting cascade. Which condition should the nurse identify as a trigger for the clotting cascade?
What is heparin therapy?
A. Heparin therapy. Rationale: The client has signs and symptoms of disseminated intravascular coagulation (DIC). Low-molecular-weight heparin is used to interfere with the clotting cascade and reduce the consumption of clotting factors by uncontrolled thrombosis. Warfarin is not used to treat DIC.
What is hemorrhagic shock?
Hemorrhagic shock is caused by blood loss, not septic shock. The nurse is caring for a client who has not responded to platelet and whole blood transfusions as treatment for acute disseminated intravascular coagulation (DIC).
What does tissue damage from bleeding use up?
D. Tissue damage from bleeding uses up clotting factors quicker than they can be replaced.
What are the symptoms of DIC?
Rationale: Manifestations of DIC include bleeding, clotting, petechiae, and joint pain. Hypotension, not hypertension, is also a manifestation of DIC. Click again to see term 👆. Tap again to see term 👆.
Can heparin be administered with a portable pump?
Rationale: Heparin may be administered by continuous infusion using a portable pump if needed for long-term therapy, as in the client with chronic DIC. The nurse is caring for a client diagnosed with placental abruption who now has disseminated intravascular coagulation (DIC).
What reinforces IV dressing with paper tape?
A. The graduate nurse reinforces the IV dressing with paper tape.
What is a D patient?
D. A patient with swelling in the lower extremities
What does DIC mean in medical terms?
A patient admitted for disseminated intravascular coagulation (DIC) reports shortness of breath, chest pain, and dark sputum when coughing.
What causes an inappropriate activation of the clotting cascade?
A. Endotoxin causes an inappropriate activation of the clotting cascade.
Who to contact regarding patient positioning?
Contact the healthcare provider for orders concerning patient positioning.
What does a graduate nurse ask a patient to state?
D. The graduate nurse asks the patient to state name, date, and location.