Disseminated intravascular coagulation

Last revised by Daniel J Bell on 10 Jul 2021

Disseminated intravascular coagulation (DIC), also known as consumption coagulopathy or defibrination syndrome, refers to a systemic phenomenon of overactivation of coagulation and fibrinolysis resulting in widespread clots forming inside blood vessels.

Patients present with bleeding and/or thrombosis, as well as subsequent organ damage.

Disseminated intravascular coagulation may lead to:

  • ischemia: insufficient blood flow (and subsequent lack of oxygen delivery) to tissue
  • infarction: tissue death (by necrosis) due to inadequate blood supply
  • damage to vital organs e.g. brain, lungs, liver, and kidneys 1

As part of homeostasis, there is a balance between coagulation (formation of clots) and fibrinolysis (breakdown of clots). 

During times of stress listed under "Etiology", this normal homeostatic balance is disrupted resulting in dysregulated coagulation and fibrinolysis. Widespread clotting occurs exhausting available clotting factors and platelets resulting in excess bleeding. An important mediator in this process is a transmembrane glycoprotein called tissue factor (TF).

The commonest causes of disseminated intravascular coagulation are:

  1. infection and sepsis
  2. malignancy
  3. trauma (including surgery) 1,2

The diagnosis is supported by laboratory findings of coagulopathy and/or fibrinolysis including:

Management focuses on treating the underlying condition. Supportive measures include helping the organs that are affected, such as:

  • ventilator support
  • hemodynamic support
  • transfusions (platelets or red blood cells)

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