Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines.
Diagnosis and treatment of disseminated intravascular coagulation (DIC) according to four DIC guidelines.
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DOI：
10.1186/2052-0492-2-15
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发表时间：
2014
影响因子：
7.1
通讯作者：
Yamashita Y
中科院分区：
文献类型：
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作者：
Wada H;Matsumoto T;Yamashita Y
弥散性血管内凝血（DIC）根据高凝和纤溶亢进的载体之和分为出血、器官衰竭、大出血和无症状型。英国血液学标准委员会、日本血栓与止血学会和意大利血栓与止血学会分别发布了DIC指南;然而，这三套指南之间存在一些差异。因此，国际血栓与止血学会（ISTH）最近协调了这些差异，并发表了DIC的诊断和治疗指南。根据日本厚生劳动省、ISTH和日本急性医学协会，有三种不同的诊断标准。第一和第二标准可用于诊断出血或大出血类型的DIC，而第三标准涵盖器官衰竭和大出血类型的DIC。除了大出血外，建议对三种类型的DIC进行基础疾病的治疗。对于出血和大出血类型的DIC患者，建议输血。同时，对于无症状型DIC，建议使用肝素治疗。对于出血和大出血类型的DIC患者，建议给予合成蛋白酶抑制剂和抗纤溶治疗。此外，天然蛋白酶抑制剂的管理，建议在DIC的器官衰竭类型的患者，而抗纤维蛋白溶解治疗不是。DIC的诊断和治疗应根据DIC的类型进行。
Disseminated intravascular coagulation (DIC) is categorized into bleeding, organ failure, massive bleeding, and non-symptomatic types according to the sum of vectors for hypercoagulation and hyperfibrinolysis. The British Committee for Standards in Haematology, Japanese Society of Thrombosis and Hemostasis, and the Italian Society for Thrombosis and Haemostasis published separate guidelines for DIC; however, there are several differences between these three sets of guidelines. Therefore, the International Society of Thrombosis and Haemostasis (ISTH) recently harmonized these differences and published the guidance of diagnosis and treatment for DIC. There are three different diagnostic criteria according to the Japanese Ministry Health, Labour and Welfare, ISTH, and Japanese Association of Acute Medicine. The first and second criteria can be used to diagnose the bleeding or massive bleeding types of DIC, while the third criteria cover organ failure and the massive bleeding type of DIC. Treatment of underlying conditions is recommended in three types of DIC, with the exception of massive bleeding. Blood transfusions are recommended in patients with the bleeding and massive bleeding types of DIC. Meanwhile, treatment with heparin is recommended in those with the non-symptomatic type of DIC. The administration of synthetic protease inhibitors and antifibrinolytic therapy is recommended in patients with the bleeding and massive bleeding types of DIC. Furthermore, the administration of natural protease inhibitors is recommended in patients with the organ failure type of DIC, while antifibrinolytic treatment is not. The diagnosis and treatment of DIC should be carried out in accordance with the type of DIC.