Iba Toshiaki, Kidokoro Akio
Department of Surgery, Juntendo University, Urayasu Hospital.
Nihon Rinsho. 2003 Jun;61(6):1010-4.
Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by systemic formation of microthrombi and fibrin deposition in the vasculature. Cancer is one of the leading cause of DIC, which often complicates bleeding tendency and organ dysfunction. Even though DIC therapy is expectant, it is still important, since the bleeding tendency limits the quality of patients' life remarkably. Heparin, low molecular weight heparin, danaparoid, protease inhibitors for coagulation factors and antithrombin III are the choices for DIC. However, since the selection of the drugs is different depending on the basal disease, it is important to understand the pathophysiology of the individual situation. In general, protease inhibitors is recommended for 'fibrinolysis dominant DIC' like DIC associated with leukemia and terminal stage solid cancer, in contrast, danaparoid and antithrombin III are the first choice for 'coagulation dominant DIC' like sepsis. Supplement of concentrated platelets and fresh frozen should be limited for the patients whose primary disease can be controlled.
弥散性血管内凝血（DIC）是一种获得性综合征，其特征是在血管系统中全身性形成微血栓和纤维蛋白沉积。癌症是导致DIC的主要原因之一，常伴有出血倾向和器官功能障碍。尽管对DIC的治疗是姑息性的，但仍然很重要，因为出血倾向会显著影响患者的生活质量。肝素、低分子量肝素、达那肝素、凝血因子蛋白酶抑制剂和抗凝血酶III是治疗DIC的选择药物。然而，由于药物的选择因基础疾病而异，了解个体情况的病理生理学很重要。一般来说，对于白血病和晚期实体癌相关的“以纤溶为主的DIC”，推荐使用蛋白酶抑制剂；相反，对于脓毒症等“以凝血为主的DIC”，达那肝素和抗凝血酶III是首选。对于原发性疾病可控制的患者，应限制浓缩血小板和新鲜冰冻血浆的补充。
