What are the indications for initiating anticoagulation therapy in a patient diagnosed with DIC?

Indications for initiating anticoagulation therapy in disseminated intravascular coagulation (DIC) primarily focus on the presence of predominant thrombotic manifestations rather than bleeding complications. Anticoagulation, typically with heparin, is considered when there is evidence of ongoing thrombosis or organ dysfunction due to microvascular clotting, despite the underlying consumptive coagulopathy ⁴. This approach aims to interrupt the pathological coagulation cascade driving DIC.

UK clinical guidelines emphasize cautious use of anticoagulation in DIC, reserving it for cases with clear thrombotic complications or when thrombosis predominates over bleeding risk. Routine anticoagulation is not recommended in patients with active bleeding or high bleeding risk ⁴.

Recent literature, including Lippi et al. (2020), explores the potential role of direct oral anticoagulants (DOACs) as therapeutic options in DIC, particularly in chronic or low-grade cases where thrombosis is a major concern and bleeding risk is manageable. However, this remains investigational and is not yet standard practice ⁴ (Lippi et al., 2020).

In summary, anticoagulation in DIC is indicated when there is clinical or laboratory evidence of thrombosis causing organ dysfunction, and bleeding risk is controlled. The decision must balance the risks of bleeding against the benefits of preventing further thrombotic complications, guided by clinical assessment and coagulation parameters.