Abstract
IntroductionIt is not clear if and how international guidelines on the management of disseminated intravascular coagulation (DIC) are translated in routine clinical practice. Materials and MethodsA survey was conducted among different specialists who treat DIC. The survey examined six hypothetical case scenarios including the diagnosis of DIC, the treatment of non-overt and overt DIC with or without thrombosis, and the management of DIC patients at risk of bleeding or actively bleeding. ResultsThere were 191 respondents and 73 returned complete questionnaires. Most of respondents were specialists in hematology (48%) or intensive care (30%). In suspected overt or non-overt DIC, only one third use formal diagnostic scores while two thirds rely on a broad panel of coagulation tests independently of any score. In non-overt DIC, 68% provide no treatment, but monitor laboratory tests. Monitoring was considered by 48% of respondents in overt DIC without thrombosis or bleeding. When a thrombotic or bleeding complication ensues, 29% consider intervening only if the event is major. In DIC patients judged at risk of bleeding, 67% use prophylactic transfusions, mostly fresh-frozen plasma (73%) and platelets (65%). Active bleeding is often managed with fresh-frozen plasma (83%) and platelet transfusions (68%) as first line and recombinant activated factor VII (31%) as second line treatment. ConclusionsThis survey shows a largely heterogeneous approach of clinicians to the diagnosis and management of DIC. There is limited use of diagnostic scores despite guidelines' recommendations. The prevalent attitude seems monitoring DIC and limiting treatment to the underlying disease, unless thrombosis or bleeding develop, but modalities varied considerably.
Published Version
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