A client has been diagnosed with Disseminated Intravascular Coagulation (DIC). Which of the following is contraindicated with the client?
A. Administering Heparin
B. Administering Coumadin
C. Treating the underlying cause
D. Replacing depleted blood products
Correct Answer: B. Administering Coumadin
Disseminated Intravascular Coagulation (DIC) has not been found to respond to oral anticoagulants such as Coumadin. Warfarin is contraindicated in patients with hemorrhagic tendencies (e.g., active GI ulceration, patients bleeding from the GI, respiratory, or GU tract; a cerebral aneurysm; central nervous system (CNS) hemorrhage; dissecting aortic aneurysm; spinal puncture and other diagnostic or therapeutic procedures with the potential for significant bleeding).
Option A: Heparin, an anticoagulant, is widely used during DIC treatment and in the prevention of thrombotic diseases. Heparin may also become necessary if a patient has extensive clotting as this medication may prevent further activation of the clotting cascade. Patients with DIC who are not actively bleeding should receive prophylactic anticoagulation with heparin or low molecular weight heparin (LMWH).
Option C: The DIC component will resolve on its own once the underlying disorder is addressed. The treatment for DIC centers on addressing the underlying disorder, which ultimately led to this condition. Consequently, therapies such as antibiotics for severe sepsis, possible delivery for placental abruption, and possible exploratory surgical intervention for trauma represent the mainstays of treatment for DIC.
Option D: Platelet and factor replacement should be directed not at simply correcting laboratory abnormalities but at addressing clinically relevant bleeding or meeting procedural needs. Platelet and plasma transfusions should only be considered in patients with active bleeding or a high risk of bleeding or those patients requiring an invasive procedure. A common threshold utilized for platelet transfusions in this patient population is less than 50 x 10^9 platelets per liter for actively hemorrhaging patients and 10-20 x 10^9 platelets per liter for those not actively bleeding but at high risk of future bleeding.