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Disseminated intravascular coagulation
1Department of Anaesthesiology, Regional Cancer Centre, Medical College Campus, Thiruvanathapuram, Kerala, India.
Insights
Disseminated intravascular coagulation (DIC) is a systemic disorder causing coagulation issues, organ dysfunction, and death. Early diagnosis and treatment of the underlying cause are crucial for reducing mortality.
Area of Science:
- Hematology
- Internal Medicine
- Critical Care Medicine
Background:
- Disseminated intravascular coagulation (DIC) is a complex systemic disorder affecting coagulation.
- It involves simultaneous pro-coagulant and fibrinolytic activation, leading to consumption coagulopathy.
- DIC can result in organ dysfunction and mortality, with sepsis being a common trigger.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and management of Disseminated intravascular coagulation (DIC).
- To highlight the importance of identifying underlying causes and utilizing diagnostic scoring systems.
- To discuss current treatment strategies and their efficacy.
Main Methods:
- Comprehensive literature review including textbook and Medline (PubMed) searches.
- Keywords: DIC, thrombosis, fibrin degradation products, anti-thrombin, tissue factor.
- Focus on evidence-based reviews and research from the past 25 years.
Main Results:
- Diagnosis requires a causative factor and supportive laboratory tests (coagulation profile, clotting factors).
- Effective scoring systems correlate with mortality risk.
- Treatment focuses on the underlying disorder; low molecular weight heparin has specific indications, while others have doubtful value.
Conclusions:
- Early diagnosis and prompt treatment of DIC, supported by laboratory findings, are essential.
- Addressing the underlying systemic disorder is the primary therapeutic goal.
- Effective management can significantly reduce morbidity and mortality associated with DIC.
Abstract:
Disseminated intravascular coagulation (DIC) is a reflection of an underlying systemic disorder which affects the coagulation system, simultaneously resulting in pro-coagulant activation, fibrinolytic activation, and consumption coagulopathy and finally may result in organ dysfunction and death. Though septicaemia is the most common cause of DIC, several other conditions can also lead to it. A diagnosis of DIC should be made only in the presence of a causative factor supported by repeated laboratory tests for coagulation profile and clotting factors. An effective scoring system helps to detect an overt DIC and a high score closely correlates with mortality. Treatment of DIC is aimed at combating the underlying disorder followed by supportive management. Low molecular weight heparin is advocated in special situations whereas anti-thrombin III and activated protein C are of doubtful value. Early diagnosis and prompt treatment backed by laboratory support can reduce the morbidity and mortality associated with it. The methodology of search for this review article involved hand search from text books and internet search using Medline (via PubMed) using key words DIC, thrombosis, fibrin degradation products, anti-thrombin and tissue factor for the last 25 years and also recent evidence-based reviews.
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