Disseminated intravascular coagulation (DIC) is an acquired syndrome characterised 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, haematuria, oliguria, cough, dyspnoea, fever, delirium, and coma. Physical examination 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.
Aggressive treatment of the underlying disorder is indicated, as well as fresh frozen plasma, platelet concentrate, antithrombin III, tissue factor pathway inhibitor, heparin, and recombinant factor VII activated for refractory haemorrhagic episodes.
Complications include life-threatening haemorrhage, acute renal failure, and gangrene and loss of digits.
Disseminated intravascular coagulation (DIC) is an acquired syndrome characterised by activation of coagulation pathways, resulting in formation of intravascular thrombi and depletion of platelets and coagulation factors. Thrombi may lead to vascular obstruction/ischaemia and multi-organ failure. Spontaneous bleeding may occur. Generalised bleeding, evidenced by at least three unrelated sites, is highly suggestive of DIC.
DIC can be triggered by major trauma, organ destruction, sepsis or severe infection (including severe coronavirus disease 2019 [COVID-19] infection), severe obstetric disorders, some malignancies, major vascular disorders, and severe toxic or immunological reactions.
History and exam
Key diagnostic factors
- presence of underlying disorders
- oliguria, hypotension, or tachycardia
- purpura fulminans, gangrene, or acral cyanosis
- delirium or coma
- petechiae, ecchymosis, oozing, or haematuria
- major trauma/burn/organ destruction or sepsis/severe infection
- severe obstetric disorders or complications
- solid tumours and haematological malignancies
- severe toxic or immunological reactions
- major vascular disorders (large aortic aneurysms or giant haemangiomas)
1st investigations to order
- platelet count
- prothrombin time (PT)
- D-dimer/fibrin degradation products
- activated partial thromboplastin time (aPTT)
- imaging studies or other tests
Investigations to consider
- thrombin time
- factor V, VIII, X, XIII
- inflammatory cytokines
- D-dimer (monoclonal antibody test)
- antithrombin III
- fibrinopeptide A (FPA)
- prothrombin fragment 1 and 2
low bleeding risk
high bleeding risk or active bleeding
- Severe liver failure
- Heparin-induced thrombocytopenia
- Idiopathic purpura fulminans
- Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC of the ISTH
- Guidelines for the diagnosis and management of disseminated intravascular coagulation (amendment to recommendation for activated protein C)
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