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Management. Control or elimination of the underlying cause Severe DIC: Control of hemodynamic parameters Respiratory support Surgery Attempts to treat DIC without treatment of the causative disease are likely to fail. Management of hemorrhagic symptoms.
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Management • Control or elimination of the underlying cause • Severe DIC: • Control of hemodynamic parameters • Respiratory support • Surgery • Attempts to treat DIC without treatment of the causative disease are likely to fail
Management of hemorrhagic symptoms • DIC with marked thrombocytopenia and low levels of coagulation factors: • Replacement therapy • FFP • Low levels of fibrinogen or brisk fibrinolysis: • Cryoprecipitate • The replacement of 10 U of cryoprecipitate for every 2-3 U of FFP is sufficient to correct the hemostasis • Platelet concentrates at a dose of 1-2 U/10 kg body weight are sufficient for most DIC patients with severe thrombocytopenia
Management • Clotting factor concentrates are not recommended for control of bleeding in DIC because of the limited efficacy afforded by the replacement of single factors
Replacement of coagulation or fibrinolysis inhibitors • Low doses of continuous infusion heparin (5-10 U/kg/h) may be effective in patients with low-grade DIC associated with solid tumor or APL or in a setting with recognized thrombosis • Antifibrinolytic drugs, EACA, Traxenamic acid • Prevent fibrin degradation by plasmin • But can increase risk for thrombosis (concomitant use of heparin is indicated) • For patients with APL, chronic DIC associated with hemangiomas • Protein C concentrates