What is Disseminated Intravascular Coagulation (DIC)?

From the Guidelines

Disseminated Intravascular Coagulation (DIC) is a serious condition where the blood's clotting mechanism becomes abnormally activated throughout the body, leading to widespread clot formation in small blood vessels while simultaneously depleting clotting factors and platelets, which results in paradoxical bleeding. DIC is not a primary disease but always occurs as a complication of another underlying condition such as severe infection (especially sepsis), trauma, malignancy, obstetric complications, or severe tissue damage. The condition creates a dangerous dual threat: microclots can block blood flow to organs causing organ damage, while the consumption of clotting factors leads to uncontrolled bleeding. Common symptoms include bleeding from multiple sites, bruising, organ dysfunction, and shock. Diagnosis typically involves laboratory tests showing decreased platelets, prolonged clotting times, elevated D-dimer levels, and reduced fibrinogen, as outlined in the ISTH overt DIC diagnostic criteria 1. Treatment focuses primarily on addressing the underlying cause while providing supportive care, which may include blood product transfusions (platelets, fresh frozen plasma, cryoprecipitate) to replace depleted clotting factors. In some cases, heparin may be used if clotting predominates over bleeding, although its use should be carefully considered due to the risk of bleeding, especially in patients with low platelet counts or active bleeding 1. The prognosis depends largely on the severity of the underlying condition and how quickly treatment is initiated, with mortality rates remaining high, particularly in cases of sepsis-induced coagulopathy, where the reported mortality can be ≥30% 1. Early detection and management of DIC are crucial, and the use of biomarkers such as anti-thrombin activity and von Willebrand factor may help in assessing endothelial injury and improving outcomes in DIC cases 1. However, more research is needed to develop better endothelium-related biomarkers and more accessible techniques for their measurement, as well as to determine the efficacy of anticoagulant therapy in patients with sepsis-induced coagulopathy 1.

Some key points to consider in the management of DIC include:

• The importance of early detection and treatment of the underlying condition
• The use of supportive care, including blood product transfusions, to replace depleted clotting factors
• The careful consideration of the use of heparin, taking into account the risk of bleeding
• The potential role of biomarkers in assessing endothelial injury and improving outcomes
• The need for further research to develop better diagnostic and therapeutic strategies for DIC.

Overall, DIC is a complex and serious condition that requires prompt and effective management to improve outcomes and reduce mortality.

From the Research

Definition and Characteristics of DIC

• Disseminated Intravascular Coagulation (DIC) is a complex and serious condition characterized by widespread activation of the coagulation cascade, resulting in both thrombosis and bleeding 2.
• It is a disorder characterized by an acute generalized, widespread activation of coagulation, which results in thrombotic complications, due to the intravascular formation of fibrin, as well as diffuse hemorrhages, due to the consumption of platelets and coagulation factors 3.
• DIC is marked by excessive thrombin generation, leading to platelet and fibrinogen activation while simultaneously depleting clotting factors, creating a paradoxical bleeding tendency 2.

Causes and Triggers of DIC

• The primary causes of DIC include sepsis, trauma, malignancies, and obstetric complications, which trigger an overactive coagulation response 2.
• Systemic activation of coagulation may occur in a variety of disorders, including sepsis, severe infections, malignancies, obstetric or vascular disorders, and severe toxic or immunological reactions 4.
• Most cases of DIC are due to pathological activation of the intrinsic coagulation systems (e.g. in sepsis), and/or the extrinsic system (e.g. in malignancy and head trauma) 5.

Diagnosis and Treatment of DIC

• Diagnosing DIC is challenging and relies on a combination of existing diagnostic criteria and laboratory tests 2.
• Diagnosis is made by finding abnormalities in at least 3 of 4 laboratory values, namely prothrombin time, platelet count, fibrinogen and fibrinogen/fibrin degradation products 5.
• Treatment strategies focus on addressing the underlying causes and may involve supportive care, anticoagulation therapy, and other supportive measures 2.
• Therapeutic strategies specific for DIC aim to control activation of blood coagulation and bleeding risk, and may include the use of antithrombin, activated protein C, tissue factor pathway inhibitor, and thrombomodulin 6.