Table of contents
Disseminated intravascular coagulation
Background
Overview
Definition
DIC is a clinicopathologic syndrome characterized by systemic activation of widespread coagulation resulting in severe bleeding and organ failure.
1
Pathophysiology
DIC is mostly caused by hypercoagulation (infection, particularly sepsis) and hyperfibrinolysis (acute promyelocytic leukemia, obstetric diseases, or aortic aneurysms).
2
Epidemiology
The incidence of DIC in the US is estimated at 18.6 cases per 100,000 person-years.
1
Disease course
Clinical manifestations include latent and compensated activation of coagulation (no obvious clinical symptoms) and overt DIC (microvascular thrombosis, multi-organ dysfunction, macrovascular thrombi resulting in venous or arterial obstruction and embolization). Sustained thrombin generation results in severe bleeding and an increased risk of death.
3
Prognosis and risk of recurrence
The in-hospital mortality of DIC in critically ill patients is 45%.
4
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of disseminated intravascular coagulation are prepared by our editorial team based on guidelines from the International Society on Thrombosis and Haemostasis (ISTH 2015,2013), the Italian Society for Haemostasis and Thrombosis (SISET 2012), and the British Committee for Standards In Haematology (BCSH 2009).
1
2
3
4
5
6
7
8
Screening and diagnosis
Classification and risk stratification
Diagnostic investigations
Medical management
General principles: as per ISTH 2013 guidelines, treat the underlying condition as the cornerstone of treatment of DIC.
B
More topics in this section
Prothrombin complex concentrate
Fibrinogen replacement
Recombinant factor VIIa
Activated protein C
Intravenous heparin
Antithrombin concentrate
Recombinant thrombomodulin
Dermatan sulfate and gabexate
Antifibrinolytic agents
Inpatient care
Therapeutic procedures
Indications for transfusion therapy
As per SISET 2012 guidelines:
Consider performing transfusion (platelets, plasma, cryoprecipitate) in patients with DIC and active bleeding.
C
Avoid performing transfusion solely based on laboratory parameters in patients with chronic DIC or without active bleeding.
D
More topics in this section
Platelet transfusion
FFP transfusion
Plasmapheresis