[Disseminated intravascular coagulation in critical obstetrical hemorrhage and severe trauma]

Disseminated intravascular coagulation (DIC) associated with critical obstetrical hemorrhage and severe trauma is classified as fibrinolytic DIC in terms of pathology and acute DIC in terms of progression. Obstetrical DIC is triggered by the influx of tissue factors from the placenta, amniotic fluid, and decidua into the maternal circulation. In contrast, trauma-related DIC is caused by vascular endothelial damage and exposure of subendothelial tissue. Specifically, in traumatic brain injury, tissue factors produced in the adventitia of cerebral blood vessels and astrocytes enter the circulation and lead to DIC. A common feature of both forms of DIC is the coexistence of consumptive coagulopathy and hyperfibrinolysis, which exacerbates massive bleeding. Therefore, the primary treatment strategy is coagulation factor replacement. In addition, antifibrinolytic therapy is effective in controlling excessive fibrinolysis. Appropriate therapeutic interventions can help reduce excessive bleeding in DIC and improve survival.