Disseminated Intravascular Coagulation vs Heparin-Induced Thrombocytopenia
Disseminated Intravascular Coagulation and Heparin-Induced Thrombocytopenia are easy to mix up on the boards. Here's a side-by-side comparison — presentation, workup, imaging, and first-line treatment — drawn from our full outlines.
Disseminated Intravascular Coagulation vs Heparin-Induced Thrombocytopenia at a glance
- Disseminated Intravascular Coagulation: Systemic activation of coagulation with simultaneous thrombosis and bleeding — always secondary to an underlying trigger.
- Heparin-Induced Thrombocytopenia: Antibody-mediated platelet activation by heparin-PF4 complexes causing paradoxical thrombosis with thrombocytopenia.
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Side-by-side comparison
| Feature | Disseminated Intravascular Coagulation | Heparin-Induced Thrombocytopenia |
|---|---|---|
| At a glance | Systemic activation of coagulation with simultaneous thrombosis and bleeding — always secondary to an underlying trigger. | Antibody-mediated platelet activation by heparin-PF4 complexes causing paradoxical thrombosis with thrombocytopenia. |
| Classic presentation | Septic patient with widespread oozing from IV sites plus thrombocytopenia, prolonged PT/PTT, low fibrinogen, and elevated D-dimer.; Bleeding: oozing from IV sites, mucosal bleeding, hematuria, GI bleeding, intracranial hemorrhage; Thrombosis: purpura fulminans (especially meningococcemia, post-infectious), digital ischemia, gangrene of… | Platelet count fall 5-10 days after starting heparin with new thrombosis — the 'paradoxical' picture of thrombocytopenia with clotting rather than bleeding.; Often asymptomatic platelet drop noticed on routine CBC 5-10 days after starting heparin; Rapid-onset HIT (within hours) in patients with heparin exposure within prior 100 days;… |
| Workup / key labs | Clinical setting consistent with DIC + thrombocytopenia + prolonged PT/PTT + low or falling fibrinogen + elevated D-dimer. Formal scoring by ISTH overt DIC score.; CBC — thrombocytopenia; Peripheral smear — schistocytes (microangiopathic hemolysis); PT prolonged, PTT prolonged (factor consumption); Fibrinogen LOW (or falling from a high… | 4Ts score 0-3 (low) → HIT unlikely; 4-5 (intermediate) and 6-8 (high) → stop heparin, start non-heparin anticoagulant, send PF4 ELISA and confirmatory functional assay. Diagnosis = clinical probability + positive functional assay.; Calculate 4Ts score: Thrombocytopenia, Timing, Thrombosis, oTher causes (each 0-2 points);… |
| Imaging | Directed by suspected underlying cause (CT abdomen/pelvis for trauma or sepsis source, head CT for hemorrhage, obstetric ultrasound) | Lower extremity venous duplex Doppler in all patients diagnosed with HIT; CT/CTA or other vascular imaging guided by clinical signs of thrombosis; CT abdomen if adrenal hemorrhage suspected |
| First-line treatment | TREAT THE UNDERLYING CAUSE — most important and definitive intervention (source control, empiric antibiotics, deliver fetus, treat APL with ATRA + arsenic, etc.); Supportive care: hemodynamic resuscitation, ventilation, renal replacement as needed; Bleeding patient: fresh frozen plasma (FFP) for prolonged PT/PTT, cryoprecipitate if… | STOP all heparin immediately (including flushes, LMWH, heparin-coated catheters); Start non-heparin anticoagulant at therapeutic dose — argatroban (direct thrombin inhibitor, hepatic clearance) or bivalirudin (DTI, predominantly enzymatic/proteolytic clearance with minor renal component) for inpatients; fondaparinux acceptable for… |
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