Disseminated Intravascular Coagulation

Question 1

What is the official definition of DIC?

Answer 1

An acquired systemic process resulting in disseminated thrombosis within microcirculation typically associated with overwhelming triggering of the coagulation system

Question 2

What is the horse definition of DIC?

Answer 2

Death is coming

Question 3

What is DIC typically initiated by in the horse?

Answer 3

Pathological expression of intravascular tissue factor and induction of production of thrombin

Question 4

DIC is the result of the animal going into an overwhelmingly ________ state.

Answer 4

Hypercoagulable

Question 5

What is the issue with hypercoagulability in microvasculature?

Answer 5

Development of tissue hypoxemia.ischemia leading to organ dysfunction and failure

Question 6

Is DIC a chronic or acute condition in horses?

Answer 6

Always acute

Question 7

Is the classical progression of DIC reliable in the horse?

Answer 7

No- it typically is rapidly deteriorating in the horse

Question 8

Why is it theorized that horses have a much bigger issue with DIC than other animals?

Answer 8

Horses have lower basal levels of antithrombin III which is exacerbated in animals with colic

Question 9

What is an additional issues leading to hypercoagulability in horses with ischemic colic?

Answer 9

Decreased fibrinolytic activity

Question 10

What percentage of endotoxemic foals develop DIC?

Answer 10

~50%

Question 11

Is DIC a primary or secondary condition in the horse?

Answer 11

Typically secondary

Question 12

What percentage of horses with inflammatory GI disease develop DIC?

Answer 12

~36%

Question 13

What percentage of horses with ischemic GI disease develop DIC?

Answer 13

~55%

Question 14

What is DIC most often associated with in horses?

Answer 14

Endotoxemia

Question 15

What other conditions is DIC associated with in horses?

Answer 15

Vasculitis causing conditions, septicemia, obsetrical problems

Question 16

How is DIC diagnosed?

Answer 16

By filling at least three of the following criteria

• Increased bleeding/clotting times
• Thrombocytopenia
• Increased FDPs (must be substantial)

Question 17

Is hypofibrinogenemia a good diagnostic indicator for DIC in the horse?

Answer 17

No

Question 18

Is there a scoring system for DIC in horses?

Answer 18

Yes- not approved but still used

Question 19

What are the indicators for DIC most often used in the horse?

Answer 19

Thrombocytopenia, prolonged PT and APTT, 3-4+ FDPs with a disease known to cause DIC

Question 20

Is treatment usually attempted in horses?

Answer 20

No, typically horses die very rapidly once diagnosed

Question 21

How do you prevent DIC?

Answer 21

Control the primary disease and minimize inflammation and vasculitis

Question 22

T/F: Hetastarch has been shown to reduce endothelial permeability and improve platelet activity.

Answer 22

True

Question 23

If DIC is in the hypercoagulable phase, what value should be checked?

Answer 23

ATIII

Question 24

Should heparin be administered to horses to prevent hypercoagulability?

Answer 24

Yes, but only if ATIII levels are normal

Question 25

What kind of heparin should be used in horses?

Answer 25

Low molecular weight heparin

Question 26

What should be done in a hypocoagulable patient?

Answer 26

Try to normalize all paramaters- platelet/plasma transfusions, ATIII

Question 27

What is the typical outcome of DIC even with treatment?

Answer 27

Death