Treatment

• First-line: treatment of the underlying disease

• Additional treatment depends on the subtype and is complicated . Involve specialists early.

  • Blood products as needed

  • Anticoagulation: if hypercoagulability is the leading problem (e.g., in organ failure type DIC)

  • Consider advanced treatment options (e.g., antithrombin) in consultation with a specialist.

• Supportive therapy

  • Avoid invasive procedures if possible

  • Vitamin K supplementation if deficiency is suspected

• Initiate clinical and serial laboratory monitoring to assess response to treatment.

The decision to transfuse blood products should primarily be based on the presence or risk of bleeding. Laboratory parameters can be used as a treatment goal but should not be considered the sole rationale for transfusion. Involve specialists early.

• pRBCs: indicated for patients with active bleeding or Hb ≤ 7 gr/dL (see “Packed red blood cells” for specific transfusion thresholds and goals and “Massive transfusion” in case of massive hemorrhage)

• Platelets

  • Indications

    • Active bleeding or high risk of bleeding (e.g, planned invasive procedure): platelet count < 50,000/mm3

    • No bleeding: platelet count < 10,000–20,000/mm3

• Fresh frozen plasma (FFP)

  • Indications

    • PT or aPTT > 1.5 times the normal value if patient is bleeding or will undergo an invasive procedure

• Cryoprecipitate

  • Indication: bleeding and fibrinogen levels < 150 mg/dL despite FFP or when FFP transfusion is not possible

Antifibrinolytic therapy

• Tranexamic acid: not routinely recommended

Anticoagulation

• Prophylactic heparin: indicated as DVT prophylaxis in critically ill patients in the absence of bleeding

• Therapeutic heparin: indicated for clinically overt thromboembolic events

• Other coagulation inhibitors: Consider in individual cases in consultation with a specialist.

  • Antithrombin (AT): Not routinely recommended due to a lack of supporting evidence.

  • Plasma-derived activated protein C (APC)

  • Recombinant human thrombomodulin (rhTM)

  • Synthetic inhibitors of serine proteases