Disseminated intravascular coagulation (DIC) remains fundamentally a disorder to treat by treating its cause — sepsis, malignancy, obstetric catastrophe, or trauma — with anticoagulant and supportive measures tailored to whether the clinical picture is predominantly thrombotic or hemorrhagic. Heparin is used when thrombosis dominates (endorsed by the ISTH), while significant bleeding or high bleeding risk is managed with platelet transfusions, fresh frozen plasma, and coagulation factor concentrates.
Attempts to add a disease-specific therapy have been only partly successful. Recombinant thrombomodulin, which promotes protein C activation and has anticoagulant and anti-inflammatory effects, did not significantly improve 28-day mortality in its large Phase 3 trial overall, though a possible benefit was seen in the subgroup with sepsis-induced coagulopathy — so it is not established as standard. Immunomodulatory approaches (colony-stimulating factors, interferon gamma, mesenchymal stem cells) for sepsis-induced DIC remain investigational.
Further reading: management of sepsis-induced coagulopathy and DIC (Iba et al., 2019); how I treat DIC (Levi & Scully, Blood 2018); recombinant thrombomodulin SCARLET trial.