Department of Medicine and Aging, Centre for Aging Sciences, CeSI, University GD'Annunzio Foundation, Chieti, Italy.
Thromb Res. 2012 May;129(5):e177-84. doi: 10.1016/j.thromres.2011.08.028. Epub 2011 Sep 17.
The diagnosis and treatment of disseminated intravascular coagulation (DIC) remain extremely controversial.
The Italian Society for Thrombosis and Haemostasis commissioned a project to develop clinical practice guidelines for the diagnosis and treatment of DIC.
Key questions about the diagnosis and treatment of DIC were formulated by a multidisciplinary working group consisting of experts in clinical medicine and research. After a systematic review and discussion of the literature, recommendations were formulated and graded according to the supporting evidence. In the absence of evidence, evidence of low quality, or contradictory evidence, a formal consensus method was used to issue clinical recommendations.
In suspected DIC, we suggest the use of the diagnostic scores ISTH (grade C), JMHW (grade C) or JAAM (grade D) over stand alone tests. The cornerstone of the management of DIC remains the treatment of the underlying triggering disease. We do not suggest the use of antithrombin (grade D), dermatan sulphate (grade D), gabexate (grade D), recombinant factor VIIa (grade D), activated protein C (grade D), thrombomodulin (grade B). The use of unfractionated heparin or low-molecular-weight heparin is not suggested except for thromboembombolic prophylaxis in patients a high risk who do not have active bleeding (grade D). In patients with severe sepsis/septic shock and DIC we suggest the use of human recombinant activated protein C (grade D). In patients with DIC and active bleeding we suggest the use of transfusion therapy (platelets, plasma, cryoprecipitate) (grade D).
弥散性血管内凝血（DIC）的诊断和治疗仍存在极大争议。
意大利血栓与止血学会委托开展了一项项目，旨在制定 DIC 的诊断和治疗临床实践指南。
由临床医学和研究领域的专家组成的多学科工作组提出了有关 DIC 诊断和治疗的关键问题。在对文献进行系统回顾和讨论后，根据证据支持情况制定并分级推荐建议。在缺乏证据、证据质量低或证据相互矛盾的情况下，采用正式的共识方法发布临床推荐。
在疑似 DIC 中，我们建议使用诊断评分 ISTH（C 级）、JMHW（C 级）或 JAAM（D 级），而不是单独的检测。DIC 管理的基石仍然是治疗潜在的触发疾病。我们不建议使用抗凝血酶（D 级）、硫酸皮肤素（D 级）、加贝酯（D 级）、重组 VII 因子（D 级）、活化蛋白 C（D 级）、血栓调节蛋白（B 级）。除非高风险且无活动性出血的患者进行血栓栓塞预防，否则不建议使用普通肝素或低分子量肝素（D 级）。在患有严重脓毒症/脓毒性休克和 DIC 的患者中，我们建议使用人重组活化蛋白 C（D 级）。在患有 DIC 和活动性出血的患者中，我们建议使用输血治疗（血小板、血浆、冷沉淀）（D 级）。
