Current approach to disseminated intravascular coagulation related to sepsis - organ failure type

Table 1 Score for disseminated intravascular coagulation diagnosis established by the Japanese Association of Acute Medicine

Parameter	Points
SIRS criteria
3 or more	1
2-0	0
Platelet count (× 103/µL)
< 80 or a reduction of > 50% in 24 h	3
80-120 or a reduction of > 30% in 24 h	1
> 120	0
Prothrombin time
1.2 times over control or higher	1
< 1.2 times over control	0
Fibrin degradation products/fibrinogen (mg/L)
25 or more	3
10 to 24	1
< 10	0
Diagnosis DIC: 4 or more points

SIRS: Systemic inflammatory response syndrome; DIC: Disseminated intravascular coagulopathy.

Table 2 Laboratory findings in sepsis-related disseminated intravascular coagulation

Test	Alteration	Other causes
Platelet count	Reduction	Bone marrow abnormalities
Anti-thrombin/C protein	Reduction	Hepatic failure, capillary leakage syndrome
Prothrombin time	Extended	Hepatic failure, vitamin K deficiency
Soluble fibrin/thrombin	Increased	VTD, surgery
vWF-PP/PAI-1	Increased	Organic failure
aPTT	Bifasic wave	Infection
ADAMTS-13	Reduction	Hepatic failure, thrombotic microangiopathy
FDP/DD	Increased	VTD, surgery

VTD: Venous thromboembolic disease; vWF-PP: Von Willebrand factor pro-peptide; PAI-1: Type 1 plasminogen activator inhibitor; ADAMTS-13: A desintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13; FDP: Fibrin degradation products; DD: D-dimer; aPTT: Activated partial thromboplastin time.

Table 3 Treatment recommendations amongst different types of disseminated intravascular coagulation

Dysfunction	Recommended treatment
Pre-DIC	Treat cause and
	UFH 70 IU/kg per day or
	LWMH anti-Xa target: 0.8-1.2
Multiple organ failure	Treat cause and
	AT 30 IU/kg per day of 3 d
Hemorrhagic	Treat cause and
	Hemo-transfusion
	Anti-fibrinolytics
	Protease synthetic inhibitor
Massive hemorrhage	Treat cause and
	Hemo-transfusion
	Anti-fibrinolytics
	Protease synthetic inhibitor

DIC: Disseminated intravascular coagulopathy; UFH: Unfractionated heparin; LWMH: Low molecular weight heparin; Xa: Activated X factor; AT: Anti-thrombin.