1st June 2023

Disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is a life-threatening consumptive coagulopathy in which the coagulation and fibrinolytic cascades are systemically activated in an uncontrolled manner due to an underlying cause such as sepsis, trauma, surgery, or pregnancy complications. The activation of the coagulation pathway results in thrombus formation within the intravascular system, leading to depletion of coagulation factors and platelets and resulting in bleeding.

DIC is associated with a high mortality and results in severe, life-threatening complications. Early aggressive treatment is key to reducing mortality. Complications can include thrombosis, severe bleeding, acute renal failure, gangrene and digit loss, haemothorax, intracranial bleeds, cardiac tamponade and death.

The International Society of Thrombosis and Haemostasis composed a diagnostic algorithm for DIC to be used in patients with a clinical suspicion of DIC. A score is calculated using the table below; a score ≥5 suggests overt DIC.

International Society of Thrombosis and Haemostasis Criteria for DIC

Causes

An underlying disorder is required to cause DIC, and therefore, DIC can only be considered in the presence of an underlying disorder. For instance, in the acute setting: sepsis, severe obstetric complications, major trauma, severe burns, severe immunological reactions and malignancies can all lead to systemic activation of the coagulation pathway causing DIC.

Treatment

The management of DIC ultimately should focus on treatment of the underlying disorder causing the DIC. In the acute setting, if there is active bleeding or there is a high bleeding risk, transfusions can be considered. Platelet transfusion should be considered if the platelet count is <20 x 10⁹/L or <50 x 10⁹/L with active bleeding. If significant bleeding is present or the patient’s fibrinogen level is <100 mg/dL, fresh frozen plasma (FFP) may be administered. Second-line treatment would include cryoprecipitates or fibrinogen concentrates.