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Highlights & Basics
- Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by activation of coagulation pathways, resulting in formation of intravascular thrombi and depletion of platelets and coagulation factors.
- Clinical history can include epistaxis, gingival bleeding, hematuria, oliguria, cough, dyspnea, fever, delirium, and coma. Physical exam may reveal petechiae, ecchymosis, gangrene, mental disorientation, hypoxia, hypotension, and gastrointestinal bleeding.
- Diagnosis is based on presence of ≥1 known underlying conditions causing DIC plus abnormal global coagulation tests: decreased platelet count, increased prothrombin time, elevated fibrin-related marker (D-dimer/fibrin degradation products), and decreased fibrinogen level.
- Active treatment of the underlying disorder is indicated. Treatment of DIC depends on the underlying condition and presentation, but options include fresh frozen plasma, platelet concentrate, antithrombin III, and heparin.
- Complications include life-threatening hemorrhage, acute renal failure, and gangrene and loss of digits.
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Citations
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Taylor FB Jr, Toh CH, Hoots WK, et al; Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the International Society of Thrombosis and Haemostasis (ISTH). Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001 Nov;86(5):1327-30.[Abstract]
Levi M, Toh CH, Thachil J, et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009 Apr;145(1):24-33.[Abstract][Full Text]
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7. Levi M, Scully M. How I treat disseminated intravascular coagulation. Blood. 2018 Feb 22;131(8):845-54.[Abstract][Full Text]
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9. Costello RA, Nehring SM. Disseminated intravascular coagulation (DIC). StatPearls [Internet]. 2019 Nov 30. [Abstract][Full Text]
10. Levi M, Toh CH, Thachil J, et al. Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology. Br J Haematol. 2009 Apr;145(1):24-33.[Abstract][Full Text]
11. Walborn A, Hoppensteadt D, Syed D, et al. Biomarker profile of sepsis-associated coagulopathy using biochip assay for inflammatory cytokines. Clin Appl Thromb Hemost. 2018 May;24(4):625-32.[Abstract][Full Text]
12. Greenberg CS. The role of D-dimer testing in clinical hematology and oncology. Clin Adv Hematol Oncol. 2017 Aug;15(8):580-3.[Abstract]
13. Xu Y, Zhu R, Sun Y, et al. Antithrombin III for early diagnosis of DIC in sepsis patients: a retrospective analysis with 445 patients [in Chinese]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Feb;29(2):127-32.[Abstract]
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16. Lemmer JH Jr, Despotis GJ. Antithrombin III concentrate to treat heparin resistance in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2002 Feb;123(2):213-7.[Abstract][Full Text]
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19. Yasuda N, Goto K, Ohchi Y, et al. The efficacy and safety of antithrombin and recombinant human thrombomodulin combination therapy in patients with severe sepsis and disseminated intravascular coagulation. J Crit Care. 2016 Dec;36:29-34.[Abstract]
20. Thachil J, Falanga A, Levi M, et al. Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC of the ISTH. J Thromb Haemost. 2015 Jan 28;13(4):671-5.[Abstract][Full Text]
21. Thachil J, Toh CH, Levi M, et al. The withdrawal of activated protein C from the use in patients with severe sepsis and DIC [Amendment to the BCSH guideline on disseminated intravascular coagulation]. Br J Haematol. 2012 May;157(4):493-4.[Abstract][Full Text]
