What is Disseminated Intravascular Coagulation (DIC)?

From the Guidelines

Disseminated intravascular coagulation (DIC) should be managed with prompt identification and treatment of the underlying condition, along with supportive care including blood product replacement and consideration of heparin therapy in select cases, as evidenced by the most recent study in 2023 1. The management of DIC involves addressing the underlying cause, which can include sepsis, trauma, malignancy, or obstetric complications.

• Key laboratory findings that suggest DIC include prolongation of PT and APTT beyond that expected by dilution, significant thrombocytopenia, and fibrinogen levels <1.0 g/L, as noted in a study from 2000 1.
• Blood product replacement is essential in the management of DIC, including fresh frozen plasma, platelet transfusions, and cryoprecipitate, as recommended in a study from 2000 1.
• Heparin therapy may be considered in cases with predominant thrombosis, but its use is controversial in bleeding patients, as discussed in a study from 2015 1.
• Continuous monitoring of coagulation parameters, including PT, PTT, fibrinogen, D-dimer, and platelet count, is crucial to guide therapy, as emphasized in the most recent study from 2023 1.
• The mortality rate for DIC remains high, ranging from 20-50%, making prompt identification and treatment of the underlying condition the most important intervention, as highlighted in the study from 2023 1.
• Endothelial dysfunction plays a critical role in the pathogenesis of DIC, and the assessment of endotheliopathy may improve early detection and outcome prediction, as noted in the study from 2023 1.
• The use of endothelium-related biomarkers may facilitate early detection and management of DIC, and further research is needed to develop better biomarkers and more accessible techniques for their measurement, as recommended in the study from 2023 1.

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.
• 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 of DIC

• The primary causes of DIC include sepsis, trauma, malignancies, and obstetric complications, which trigger an overactive coagulation response 2.
• DIC is always secondary to an underlying condition, such as severe infections, solid or hematologic malignancies, trauma, or obstetric calamities 3.

Diagnosis of DIC

• Diagnosing DIC is challenging and relies on a combination of existing diagnostic criteria and laboratory tests 2.
• The International Society for Thrombosis and Haemostasis (ISTH) DIC scoring system provides an objective measurement of DIC 4.
• A reliable diagnosis of DIC can be made through simple scoring algorithms based on readily available routine hemostatic parameters 3.

Treatment of DIC

• The cornerstone of the management of DIC is the treatment of the underlying condition triggering the coagulopathy 5.
• Treatment strategies focus on addressing the underlying causes and may involve supportive care, anticoagulation therapy, and other supportive measures 2.
• Supportive management should vary according to the underlying cause, clinical manifestations, and severity of blood test abnormalities 5.
• Platelet transfusion should be given to maintain platelet count > 50×10⁹/l in case of bleeding, while a lower threshold of 20 to 30×10⁹/l may be used in DIC without bleeding 5.
• Thromboprophylaxis with low-molecular-weight heparin is advised until bleeding ensues or platelet count drops below 30×10⁹/l 5.
• Administration of heparin may be useful, and restoration of physiological anticoagulants has been suggested, but has not been proven successful in improving clinically relevant outcomes so far 3.
• In patients with major bleeding or at risk for hemorrhagic complications, administration of platelet concentrates, plasma, or coagulation factor concentrates should be considered 3.