Disseminated Intravascular Coagulation

Introduction

The majority of critically ill patients have coagulation abnormalities.1 These abnormalities range from subtle activation of coagulation that can only be detected by sensitive markers for coagulation factor activation to somewhat more stronger coagulation activation that may be detectable by a small decrease in platelet count and subclinical prolongation of global clotting times to fulminant disseminated intravascular coagulation (DIC), characterized by simultaneous widespread microvascular thrombosis and profuse bleeding from various sites.2 Patients with severe forms of DIC may present with manifest thromboembolic disease or clinically less apparent microvascular fibrin deposition that predominantly presents as multiple organ dysfunction.3, 4 Alternatively, severe bleeding may be the leading symptom,5 but quite often a patient with DIC has simultaneous thrombosis and bleeding. Bleeding is caused by consumption and subsequent exhaustion of coagulation proteins and platelets due to the ongoing activation of the coagulation system.6

Abstract

OBJECTIVES

To review the current knowledge on the clinical manifestation, pathogenesis, diagnosis, and management of disseminated intravascular coagulation (DIC).

DATA SOURCES

Selected articles from the Medline database.

RESULTS

DIC may complicate a variety of disorders and can cause significant morbidity (in particular related to organ dysfunction and bleeding) and may contribute to mortality. The pathogenesis of DIC is based on tissue factor-mediated initiation of systemic coagulation activation, insufficiently contained by physiological anticoagulant pathways, and amplified by impaired endogenous fibrinolysis. The diagnosis of DIC can be made using routinely available laboratory tests and scoring algorithms. Supportive treatment of DIC may be aimed at replacement of platelets and coagulation factors, anticoagulant treatment, and restoration of anticoagulant pathways.>

CONCLUSION

Insight into the pathogenesis of DIC has resulted in better strategies for clinical management including straightforward diagnostic criteria and potentially beneficial supportive treatment options.

Keywords

disseminated intravascular coagulation, thrombosis, bleeding, platelets, coagulation factors, antithrombin, protein C, tissue factor, fibrinolysis