Department of Molecular and Laboratory Medicine, Mie University School of Medicine, 2-174, Edobashi, Tsu, Mie-ken 514-8507, Japan.
Thromb Res. 2010 Jan;125(1):6-11. doi: 10.1016/j.thromres.2009.08.017. Epub 2009 Sep 25.
The present report from The Japanese Society of Thrombosis and Hemostasis provides an expert consensus for the treatment of disseminated intravascular coagulation (DIC) in Japan. Disseminated intravascular coagulation (DIC) may be classified as follows: asymptomatic type, marked bleeding type, and organ failure type. Although treatment of DIC is important, adequate treatment differs according to type of DIC. In asymptomatic DIC, low molecular weight heparin (LMWH), synthetic protease inhibitor (SPI), and antithrombin (AT) are recommended, although these drugs have not yet been proved to have a high degree of effectiveness. Unfractionated heparin (UFH) and danaparoid sodium (DS) are sometimes administrated in this type, but their usefulness is not clear. In the marked bleeding type, LMWH, SPI, and AT are recommended although these drugs do not have high quality of evidence. LMWH, UFH, and DS are not recommended in case of life threatening bleeding. In case of severe bleeding, SPI is recommended since it does not cause a worsening of bleeding. Blood transfusions, such as fresh frozen plasma and platelet concentrate, are also required in cases of life threatening bleeding. In the organ failure type, including sepsis, AT has been recommended based on the findings of several clinical trials. DIC is frequently associated with thrombosis and may thus require strong anticoagulant therapy, such as LMWH, UFH, and DS.
本报告来自日本血栓与止血学会，提供了日本弥散性血管内凝血 (DIC) 的治疗专家共识。弥散性血管内凝血 (DIC) 可分为以下几类：无症状型、明显出血型和器官衰竭型。虽然治疗 DIC 很重要，但根据 DIC 的类型，适当的治疗方法也有所不同。在无症状型 DIC 中，推荐使用低分子肝素 (LMWH)、合成蛋白酶抑制剂 (SPI) 和抗凝血酶 (AT)，尽管这些药物的疗效尚未得到充分证实。在该类型中，有时也会使用未分级肝素 (UFH) 和达那肝素钠 (DS)，但其有效性尚不清楚。在明显出血型中，推荐使用 LMWH、SPI 和 AT，尽管这些药物没有高质量的证据支持。在危及生命的出血情况下，不建议使用 LMWH、UFH 和 DS。在严重出血的情况下，由于不会加重出血，因此推荐使用 SPI。在危及生命的出血情况下，还需要输注新鲜冷冻血浆和血小板浓缩物等血液制品。在包括脓毒症在内的器官衰竭型中，基于几项临床试验的结果，推荐使用 AT。DIC 常伴有血栓形成，因此可能需要进行强力抗凝治疗，如 LMWH、UFH 和 DS。
