Screening tests of disseminated intravascular coagulation: Guidelines for rapid and specific laboratory diagnosis

Objective: To study the clinician's ordering pattern in the diagnosis of disseminated intravascular coagulation (DIC) and to analyze the utility of selected tests by assessing their sensitivity, specificity, and overall efficiency. Design: Retrospective, nonrandomized, clinical study. Setting: University hospital intensive care units. Patients: A total of 82 inpatients treated in our intensive care units were identified from the hospital computer system as having been tested for Die in a I-month period. Intervention: Screening tests for DIG were ordered for the suspected patients. Measurements and Main Results:Prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen/fibrin degradation products (FDP), and fibrinogen were used most frequently as DIC diagnostic tests. The FDP and D-dimer combination (n = 39) had the highest diagnostic efficiency of 95%, with sensitivity being 91% and specificity 94%. This is followed by FDP (n = 71), efficiency 87%, sensitivity 100%, and specificity 67%; PT/PTT and FDP combination (n = 71), efficiency 86%, sensitivity 91%, and specificity 71%; and D-dimer (0 = 44), efficiency 80%, sensitivity 91%, and specificity 68%. The rest of the commonly used tests, such as PT, PTT, thrombin time, platelet count, fibrinogen, and the presence of schistocytes (n = 80), had individually either low specificity or low sensitivity and, therefore, low efficiency scores (57%, 57%, 70%, 67%, 65%, and 51%, respectively). Conclusions: The D-dimer and FDP tests offered the best test panel in the diagnosis of Die. We propose the use of D-dimer, FDP, and antithrombin as the DIG diagnostic test panel, with D-dimer and FDP providing a rapid and specific diagnosis, antithrombin providing insight to the severity and prognosis, and FDP (rapid and less expensive than D-dimer) to follow-up the progress of the condition once the diagnosis is established.