From the Guidelines
Disseminated Intravascular Coagulation (DIC) is a life-threatening complication characterized by the intravascular activation of coagulation with loss of localization, arising from different causes, which can originate from and cause damage to the microvasculature, leading to organ dysfunction 1.
Definition and Pathogenesis
DIC is not a primary disease but occurs as a complication of other severe medical conditions such as sepsis, trauma, malignancy, obstetric complications, or severe tissue damage. The condition creates a dangerous dual threat: microclots can block blood flow to organs causing tissue damage and organ failure, while the consumption of clotting factors leads to uncontrolled bleeding from multiple sites.
Diagnosis and Diagnostic Criteria
Diagnosis involves laboratory tests showing decreased platelets, prolonged clotting times, elevated D-dimer levels, and reduced fibrinogen. The International Society on Thrombosis and Haemostasis (ISTH) released the diagnostic criteria for overt DIC in 2001, which includes decreased platelet count, prolonged prothrombin time, increased fibrin-related marker, and decreased fibrinogen level 1. Additionally, the ISTH introduced the sepsis-induced coagulopathy (SIC) scoring system in 2019 to detect the compensated phase of DIC in sepsis, which can lead to overt DIC with disease progression 1.
Treatment and Management
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, and in some cases, anticoagulation therapy with heparin if clotting predominates. The effectiveness of anticoagulant therapy for sepsis-associated DIC is controversial, but recent studies report that anticoagulant therapy may improve outcomes in septic patients with coagulopathy or DIC 1.
Mortality and Outcome
The mortality rate for DIC remains high, particularly when the underlying condition cannot be effectively treated, making prompt recognition and intervention critical. A recent nationwide study performed in Japan revealed that the mortality of septic patients with DIC was 24.8% 1. The reported mortality of SIC was ≥30%, highlighting the importance of early detection and management of DIC 1.
Key Points
- DIC is a life-threatening complication of severe medical conditions
- Diagnosis involves laboratory tests and diagnostic criteria such as the ISTH overt DIC criteria and SIC scoring system
- Treatment focuses on addressing the underlying cause and providing supportive care
- Anticoagulant therapy may improve outcomes in septic patients with coagulopathy or DIC
- Prompt recognition and intervention are critical to improve outcomes in DIC patients.
From the Research
Definition and Characteristics of Disseminated Intravascular Coagulation (DIC)
- Disseminated intravascular coagulation (DIC) is a condition characterized by widespread intravascular activation of coagulation, resulting in both thrombotic and hemorrhagic complications 2, 3, 4, 5, 6.
- DIC is triggered by various underlying conditions, including sepsis, trauma, malignancies, and obstetric complications, which lead to an overactive coagulation response 3, 4, 6.
- The pathophysiology of DIC involves inflammatory cytokine-initiated activation of tissue factor-dependent coagulation, insufficient control of anticoagulant pathways, and plasminogen activator inhibitor 1-mediated suppression of fibrinolysis 3.
Clinical Manifestations and Diagnosis of DIC
- The clinical manifestations of DIC can vary from prothrombotic to hemorrhagic, depending on the underlying disease 2.
- Diagnosing DIC is challenging and relies on a combination of existing diagnostic criteria and laboratory tests, including global haemostatic test parameters 3, 6.
- The International Society on Thrombosis and Haemostasis (ISTH) established a DIC diagnostic scoring system, which has been well validated in diverse clinical settings 3.
Management and Treatment of DIC
- The theoretical cornerstone of DIC management is the specific and vigorous treatment of the underlying conditions, and DIC should be simultaneously managed to improve patient outcomes 3, 6.
- Treatment strategies focus on addressing the underlying causes and may involve supportive care, anticoagulation therapy, and other supportive measures 2, 4, 5, 6.
- Recent advances in understanding the pathophysiology of DIC are paving the way for more targeted therapeutic approaches, including the use of anticoagulation therapy with antithrombin concentrates and recombinant thrombomodulin 2.