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Published on: September 9, 2012
Disseminated intravascular coagulation: an update on pathogenesis and diagnosis
Marcel Levi1,2, Suthesh Sivapalaratnam3,4
1a Department of Medicine , University College London Hospitals NHS Foundation Trust , London , United Kingdom.
Insights
Disseminated intravascular coagulation (DIC) involves systemic coagulation activation, often seen in sepsis or trauma. Recent research offers better understanding of DIC pathophysiology and improved diagnostic tools for clinical practice.
Area of Science:
- Hematology
- Critical Care Medicine
- Pathophysiology
Background:
- Systemic activation of the hemostatic system is common in various clinical conditions.
- Severe coagulation activation in settings like sepsis, trauma, or malignancy can lead to disseminated intravascular coagulation (DIC).
Purpose of the Study:
- To review the clinical manifestations, relevance, and precipitating conditions of DIC.
- To explore the pathogenetic pathways underlying hemostatic derangement in DIC.
- To discuss the diagnostic approach to DIC.
Main Methods:
- Review of clinical and experimental studies on DIC.
- Analysis of pathogenetic pathways and clinical manifestations.
- Evaluation of diagnostic algorithms for DIC.
Main Results:
- Recent insights have improved understanding of DIC pathophysiology.
- New adjunctive treatment strategies are emerging based on this understanding.
- Validated, simple diagnostic algorithms for DIC are now available.
Conclusions:
- Enhanced understanding of DIC pathophysiology provides targets for improved treatment.
- Validated diagnostic algorithms facilitate clinical diagnosis of DIC.
- DIC remains a critical complication in various severe clinical conditions.
Introduction:
Activation of the hemostatic system can occur in many clinical conditions. However, a systemic and strong activation of coagulation complicating clinical settings such as sepsis, trauma or malignant disease may result in the occurrence disseminated intravascular coagulation (DIC). Areas covered: This article reviews the clinical manifestation and relevance of DIC, the various conditions that may precipitate DIC and the pathogenetic pathways underlying the derangement of the hemostatic system, based on clinical and experimental studies. In addition, the (differential) diagnostic approach to DIC is discussed. Expert commentary: In recent years a lot of precise insights in the pathophysiology of DIC have been uncovered, leading to a better understanding of pathways leading to the hemostatic derangement and providing points of impact for better adjunctive treatment strategies. In addition, simple diagnostic algorithms have been developed and validated to establish a diagnosis of DIC in clinical practice.
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