Disseminated Intravascular Coagulation Flashcards
What is the official definition of DIC?
An acquired systemic process resulting in disseminated thrombosis within microcirculation typically associated with overwhelming triggering of the coagulation system
What is the horse definition of DIC?
Death is coming
What is DIC typically initiated by in the horse?
Pathological expression of intravascular tissue factor and induction of production of thrombin
DIC is the result of the animal going into an overwhelmingly ________ state.
Hypercoagulable
What is the issue with hypercoagulability in microvasculature?
Development of tissue hypoxemia.ischemia leading to organ dysfunction and failure
Is DIC a chronic or acute condition in horses?
Always acute
Is the classical progression of DIC reliable in the horse?
No- it typically is rapidly deteriorating in the horse
Why is it theorized that horses have a much bigger issue with DIC than other animals?
Horses have lower basal levels of antithrombin III which is exacerbated in animals with colic
What is an additional issues leading to hypercoagulability in horses with ischemic colic?
Decreased fibrinolytic activity
What percentage of endotoxemic foals develop DIC?
~50%
Is DIC a primary or secondary condition in the horse?
Typically secondary
What percentage of horses with inflammatory GI disease develop DIC?
~36%
What percentage of horses with ischemic GI disease develop DIC?
~55%
What is DIC most often associated with in horses?
Endotoxemia
What other conditions is DIC associated with in horses?
Vasculitis causing conditions, septicemia, obsetrical problems
How is DIC diagnosed?
By filling at least three of the following criteria
- Increased bleeding/clotting times
- Thrombocytopenia
- Increased FDPs (must be substantial)
Is hypofibrinogenemia a good diagnostic indicator for DIC in the horse?
No
Is there a scoring system for DIC in horses?
Yes- not approved but still used
What are the indicators for DIC most often used in the horse?
Thrombocytopenia, prolonged PT and APTT, 3-4+ FDPs with a disease known to cause DIC
Is treatment usually attempted in horses?
No, typically horses die very rapidly once diagnosed
How do you prevent DIC?
Control the primary disease and minimize inflammation and vasculitis
T/F: Hetastarch has been shown to reduce endothelial permeability and improve platelet activity.
True
If DIC is in the hypercoagulable phase, what value should be checked?
ATIII
Should heparin be administered to horses to prevent hypercoagulability?
Yes, but only if ATIII levels are normal
What kind of heparin should be used in horses?
Low molecular weight heparin
What should be done in a hypocoagulable patient?
Try to normalize all paramaters- platelet/plasma transfusions, ATIII
What is the typical outcome of DIC even with treatment?
Death
