Disseminated intravascular coagulation

Last reviewed: 22 Aug 2023
Last updated: 04 Nov 2021



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 hematuria
More key diagnostic factors

Risk factors

  • major trauma/burn/organ destruction or sepsis/severe infection
  • severe obstetric disorders or complications
  • solid tumors and hematologic malignancies
  • severe toxic or immunologic reactions
  • major vascular disorders (large aortic aneurysms or giant hemangiomas)
More risk factors

Diagnostic investigations

1st investigations to order

  • platelet count
  • prothrombin time (PT)
  • fibrinogen
  • D-dimer/fibrin degradation products
  • activated partial thromboplastin time (aPTT)
  • imaging studies or other tests
More 1st investigations to order

Investigations to consider

  • thrombin time
  • factor V, VIII, X, XIII
More investigations to consider

Emerging tests

  • inflammatory cytokines
  • D-dimer (monoclonal antibody test)
  • antithrombin III
  • fibrinopeptide A (FPA)
  • prothrombin fragment 1 and 2

Treatment algorithm


low bleeding risk

high bleeding risk or active bleeding


chronic DIC



Haibo Wang, MD, PhD

Assistant Professor - Gratis

LSU Health Sciences Center Shreveport (LSUHSC-S)



Staff Anesthesiologist

JPS Health Network

Department of Anesthesiology

Fort Worth



HW declares that he has no competing interests.


Dr Haibo Wang would like to gratefully acknowledge Dr Frank G. Zavisca, a previous contributor to this topic.


FGZ declared he had no competing interests.

Peer reviewers

Alan Kaye, MD, PhD, DABPM

Professor and Chairman

Department of Anesthesiology

LSU School of Medicine

New Orleans



AK is on the speakers' bureau of Baxter Corporation and Hospira Corporation.

Cheng-Hock Toh, MB, ChB, MD, FRCP, FRCPath

Professor of Haematology

University of Liverpool




CHT is an author of a reference cited in this topic.

  • Differentials

    • Severe liver failure
    • Heparin-induced thrombocytopenia
    • Idiopathic purpura fulminans
    More Differentials
  • Guidelines

    • Management of cancer-associated disseminated intravascular coagulation: guidance from the SSC and ISTH
    • Guidelines for the diagnosis and management of disseminated intravascular coagulation (amendment to recommendation for activated protein C)
    More Guidelines
  • Patient leaflets

    Disseminated intravascular coagulation

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer