Disseminated intravascular coagulation treatment

Diagnosis and treatment of disseminated intravascular coagulation, a severe hemorrhagic disorder. 

Dantrolene should be repeated after 5—8 hr. Bicarbonate, procaine amide, and other drugs should be repeated as needed. Treatment of disseminated intravascular coagulation is symptomatic. Early diagnosis and treatment ofMH is essential. After effective treatment, the patient should be watched closely in the intensive care unit for recurrence of MH, myoglobinuric renal failure, disseminated intravascular coagulation, muscle weakness, and electrolyte imbalance. 

Francini M. Pathophysiology, diagnosis and treatment of disseminated intravascular coagulation An update. Clin Lab 2005 51(11—12) 633—639. 

G. Other applications Lepirudin is also under study for the treatment of myocardial infarction and unstable angina and other thromboembolic disorders requiring parenteral antithrombotic therapy such as disseminated intravascular coagulation, in adults. 

Cytokines, eg, interferons, interleukins, tumor necrosis factor (TNF), and certain growth factors, could have antitumor activity direcdy, or may modulate cellular mechanisms of antitumor activity (2). Cytokines may be used to influence the proliferation and differentiation of T-cells, B-cells, macrophage—monocyte, myeloid, or other hematopoietic cells. Alternatively, the induction of interferon release may represent an important approach for synthetic—medicinal chemistry, to search for effective antiinflammatory and antifibrotic agents. Inducers of interferon release may also be useful for lepromatous leprosy and chronic granulomatous disease. The potential cytokine and cytokine-related therapeutic approaches to treatment of disease are summarized in Table 4. A combination of cytokines is a feasible modality for treatment of immunologically related diseases however, there are dangers inherent in such an approach, as shown by the induction of lethal disseminated intravascular coagulation in mice administered TNF-a and IFN-y. 

More recently, LMWHs are being used for specific indications such as percutaneous transluminal coronary angioplasty (PTCA), as adjuncts to thrombolytic agents in disseminated intravascular coagulation (DIC) and the hypercoagulable state. A recent study has reported on the inhibition of cellular proliferation after experimental balloon angioplasty by LMWH in rabbits (25). There are several other indications such as the treatment of cardiovascular disorders where these agents may also prove to be useful. 

Kumon K, Tanaka K, NakqimaN, Naito Y, Fijuta T Anticoagulidon with a synthetic thrombin inhibitor after cardiovascular surgery and for treatment of disseminated intravascular coagulation. Crit Carehfed (1984) 12 1039-1043. 

Tenamfetamine ( ecstasy, MDMA methylenedioxymethamphetamine) is structurally related to mescaline as well as to amphetamine. It was originally patented in 1914 as an appetite suppressant and has recently achieved widespread popularity as a dance drug at rave parties (where it is deemed necessary to keep pace with the beat and duration of the music popular names reflect the appearance of the tablets and capsules and include White Dove, White Burger, Red and Black, Denis the Menace). Tenamfetamine stimulates central and peripheral a-and p-adrenoceptors thus the pharmacological effects are compounded by those of physical exertion, dehydration and heat. In susceptible individuals (poor metabolisers who exhibit the CYP450 2D6 polymorphism) a severe and fatal idiosyncratic reaction may occur with fulminant hyperthermia, convulsioirs, disseminated intravascular coagulation, rhabdomyolysis, and acute renal and hepatic failure. Treatment includes activated charcoal, diazepam for convulsions, P-blockade (atenolol) for tachycardia, a-blockade (phentolamine) for hypertension, and dantrolene if the rectal temperature exceeds 39°C. 

Intensive care Patients with ALE or with decompensated chronic liver insufficiency (such as coma stages II-IV, refractory ascites, hepatorenal syndrome, disseminated intravascular coagulation, gastrointestinal bleeding) require monitoring and treatment in an intensive care unit, preferably in a transplantation centre. (7,13,60, 66, 77)... 

Accidental venous intravasation of barium during administration of a barium enema usually has a high immediate mortality, due to barium embolism in the lungs, but it occasionally causes few symptoms. In one intermediate case there was hypotension and evidence of disseminated intravascular coagulation (SEDA-9, 407) the patient recovered after intensive treatment. 

Most severe reactions to contrast media are associated with cardiovascular manifestations, causing hypotensive shock and in some cases ventricular fibrillation and cardiac arrest these events are reversible in most cases in which prompt treatment is given. In a case of hypotensive collapse reported in 1977, and followed by a small number of others, there was disseminated intravascular coagulation (50). In milder cases there is only hypotension, which can be transient and symptomless in some cases there is bradycardia (due apparently to vagal overactivity) rather than tachycardia. 

The administration of prothrombin complex concentrate to reverse anticoagulant treatment has been associated with thrombotic complications, such as disseminated intravascular coagulation (8). However, such complications have typically occurred in patients with liver failure or after repeated treatment, such as in patients with hemophilia B treated with prothrombin complex concentrate (9). 

Rodie PH, Stirling C, Mayne EE, Ludlam CA. Thrombosis and disseminated intravascular coagulation following treatment with the prothrombin complex concentrate, DEFIX. Thromb Haemost 1999 81(4) 667. 

A 46-year-old woman died of severe disseminated intravascular coagulation after her third monthly dose of rifampicin, given with daily dapsone for the treatment of leprosy (41). 

Fresh frozen plasma contains the components of the coagulation system and is indicated for the replacement of deficient coagulation factors II, V, VII, X, XI, and XIII. Factor VIII and IX deficiencies are treated with specific factor concentrates. Fresh frozen plasma is also used for the rapid reversal of warfarin anticoagulation and in the treatment of disseminated intravascular coagulation. Thrombotic thrombocytopenic purpura is treated by means of therapeutic plasma exchange with fresh frozen plasma as the replacement fluid. Cryo-precipitate, which contains factor VIII, von Willebrand s factor, and fibrinogen, is indicated for the treatment of von Willebrand s disease that does not respond to desmopressin acetate, and for fibrinogen replacement (see Chap. 100). 

The optimal approach for patients with disseminated intravascular coagulation remains to be determined. The goal of treatment is to diagnose and treat the underlying disease. 

Bick RL. Disseminated intravascular coagulation Current concepts of etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin North Am 2003 17 149-176. 

Maruyama I. Recombinant thrombomodulin and activated protein C in the treatment of disseminated intravascular coagulation. Thromb Haemost 1999 82 718-721. 

Heparin (50(X) to 7500 units IV push) is used in the treatment of pulmonary embolism, in prophylaxis of embolism, in open-heart surgery, in disseminated intravascular coagulation, and in an effort to maintain patency of IV indwelling catheters. 

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