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DIC: Marker Recovery Time in Therapy

From “Siddhartha,” In disseminated intravascular coagulopathy (DIC) patients, what is the minimum time for the coagulation parameters D-dimer, fibrin degradation products (FDP) and fibrinogen to return to normal levels post frozen plasma (FFP) transfusion? Is it really worthwhile to do these tests in a suspected case of DIC who has already received FFP? Thanks, Siddhartha.

Hello, Siddhartha, and thank you for your question. I’ve found no studies addressing DIC markers and their return to normal, though there are many that list the markers used to identify DIC early after the appearance of symptoms. These include platelet count, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, D-dimer, FDPs, and fibrin monomer. For instance, see Sawamura A, Hayakawa M, Gando S, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res 2009;124:608–13. This article lists the early rise of ISTH and Japanese Acute Medicine markers.

I’d like to throw this question open to our participants for comment. I’ll speculate that, because fibrinogen, FDPs, and D-dimer are acute phase reactants, their return to normal is too slow and variable to be of any value in tracking the efficacy of therapy. Their variation relates to the source of DIC, for instance, markers are likely to remain higher for extended periods in sepsis but return to normal in a shorter interval in trauma. However, the more generalized assays fibrin monomer, and even PT, PTT, and platelet count, which are less sensitive to inflammation, are probably the best markers for return to normal coagulation. Any responses?

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