Читать книгу Pathy's Principles and Practice of Geriatric Medicine - Группа авторов - Страница 570

Chronic DIC manifests very differently from acute DIC. The cause is usually, but not exclusively, disseminated malignancy or vascular malformation such as abdominal aneurysm, which may be manifest but may often remain occult for weeks or months after the initial presentation. Patients usually present with bruising from thrombocytopenia and on further investigation are found to have, in addition to thrombocytopenia, hypofibrinogenaemia and elevated D‐dimers. Bleeding is a rare manifestation of this condition, although bruising is common, while thrombosis in the form of superficial thrombophlebitis and deep venous thrombosis is common. Furthermore, sterile nonbacterial endocarditis is well recognized, which can result in presentation with arterial embolization.¹⁰

Thus, the hallmarks of this condition are arterial and venous thrombosis rather than bleeding. The condition will usually resolve if the underlying cause can be successfully treated. If it cannot, the cautious application of anticoagulation rather than blood product support is the mainstay of treatment. Warfarin is notoriously difficult to use in this condition; low‐molecular‐weight heparin is the treatment of choice in terms of both efficacy and improving overall outcome, although some success has been achieved with the use of oral therapy in the form of direct‐acting oral anticoagulants (DOACs) such as rivaroxaban and apixaban. The treatment can be monitored with the platelet count and D‐dimers. Successful treatment results in increased platelet count, reduction in D‐dimer, and suppression of the chronic DIC.