Disseminated intravascular coagulation (DIC) is a thrombo-hemorrhagic complication (involving blood clotting or bleeding) characterized by deposition of fibrin (a fibrous protein) in the bloodstream, which occurs in the course of various diseases including acute and chronic leukemia. DIC is never considered as an isolated clinical entity and represents a hematological emergency. DIC therefore requires treatment and resolution of the underlying disease in addition to other approaches, such as antibiotic therapy, replacement of blood products and fluid therapy, which are considered 'primary' or 'conventional care' interventions. DIC is accompanied by hyperfibrinolysis (increased dissolution of blood clots) and reduction of natural anticoagulants (proteins of the coagulation cascade), therefore pharmacological interventions such as tranexamic acid (an antifibrinolytic agent) and heparin (an anticoagulant) have been used for treating patients with this acquired disorder. However, this practice is not considered standard care and there is plenty controversy about its effectiveness. We therefore reviewed the clinical effectiveness and safety of anticoagulant and antifibrinolytic therapy for treating DIC in patients with acute or chronic leukemia.
This review found that current evidence is supported by only four clinical trials which have assessed human activated protein C, recombinant human soluble thrombomodulin, tranexamic acid and dermatan sulphate in which 126 patients were treated. The included RCTs were classified as: 1) including patients with or without leukemia, and 2) only including patients with leukemia. The first group of the trials was not reported for the leukemia subgroup. We were not able to pool results from studies due to the inconsistency in the measurement and reporting of mortality and bleeding data. Furthermore, these trials have a high risk of bias ruling out the possibility of determining which intervention is beneficial or harmful.