Treatment of DIC can be confusing and is often controversial. There is an almost global perception that therapy is often futile and most patients with DIC die. Despite this gloomy prediction, patients with DIC can survive, if the underlying cause is a treatable illness and the coagulation abnormalities are treated appropriately.

While treatment of DIC needs to be individualized, the following principles are helpful:

• Diagnose and remove or treat the underlying cause of the DIC.
  
  This is, by far, the most critically important aspect of successful out-come. If the underlying cause cannot be identified and removed, or alleviated, even heparin treatment may be of little benefit.
  
  Unfortunately, the underlying disease itself is often life-threatening.
  
• Supportive care.
  
  Supportive patient care is an essential component of case management. It is important to maintain good tissue perfusion to dilute activated coagulation factors, flush thrombi from the microvasculature, and maintain tissue integrity. Supportive care includes aggressive therapy with crystalloids or colloids, and prevention and treatment of secondary complications such as hypoxemia, acidemia, cardiac arrhythmias, and bacterial infections.
  
• Control ongoing DIC with anticoagulant treatment, to inhibit in vivo coagulation. This is a scary concept in a bleeding patient, but is an important component of treatment if the patient continues to bleed or clot significantly.
  
  Heparin is considered the most effective anticoagulant for DIC. Dosage recommendations for heparin use in dogs and cats vary greatly: 5-10 U/kg SC q 6h (mini-dose); 75-100 U/kg SC q 6h (low dose); 200-500 U/kg SC q 6h (intermediate dose); and 750-1000 U/kg SC q 6h (high dose).
  
  Unfortunately, there are no studies to indicate which dosage is most appropriate for animal DIC patients.
  
  In people with DIC, a low dose is used most frequently, and there are studies suggesting that this dosage is as effective as larger doses. This dose of heparin is also unlikely to iatrogenically worsen the bleeding disorder.
  
  Heparin works via increasing the activity of AT-III, which is often decreased in patients with DIC. Transfusion to replace AT-III in order for heparin to be more effective should be considered a routine adjunct to heparin treatment. The preferred source of AT-III for dogs is plasma from which cryoprecipitate has been removed (so-called cryosupernatant plasma, available commercially from animal blood banks). This product is recommended to reduce the amount of fibrinogen and other infused procoagulants. In the presence of uncontrolled DIC, aggressive transfusion of blood products containing fibrinogen may make the DIC worse rather than better.
  
  Aspirin is not an effective treatment in most patients with acute DIC, but can be used to manage chronic cases or help prevent reoccurrence.
  
• Management of DIC also includes transfusion therapy. If the patient continues to bleed after attempts to treat the triggering cause of the DIC and after initiating anticoagulant therapy, transfusion support to replace consumed coagulation factors (cryosupernatant or fresh-frozen plasma), red cells (packed red cells, whole blood, or hemoglobin product) and/or platelets (fresh whole blood, platelet-rich plasma) may be needed. Repeated transfusions may be necessary.
  
  The prognosis for dogs and cats with DIC is guarded to grave, depending mainly on the initiating cause of the DIC. If, however, the inciting cause can be controlled, animals should recover with appropriate management treatment.

References: Feldman et al, JAVMA 179: 151-154, 1981; Levi and TenCate, N Eng J Med 341: 586-592, 1999; Bateman et al, JAVMA 215: 798-804, 1999; Stokol et al, AJVR 61: 393-398, 2000.