Disseminated Intravascular Coagulation

Disseminated intravascular coagulation (DIC) is an uncommon but potentially fatal acquired syndrome resulting from the aberrant systemic activation of the clotting cascade that leads to the consumption of procoagulant factors and platelets causing both micro- and macrovascular thrombi and hemorrhage simultaneously. The phenomenon is seen among approximately 1% of admissions to tertiary hospitals and has been described in two distinct phases: acute DIC, which is usually catastrophic and characterized by widespread thrombi with subsequent multiorgan failure and/or major hemorrhage, or chronic DIC, which is a more subclinical syndrome stemming from advanced mucin-secreting adenocarcinoma. The DIC is almost always secondary to a triggering condition, most commonly sepsis. Up to half of all cases of DIC are seen among patients with severe sepsis, while approximately 10% of cases are seen among patients with trauma, malignancy, or obstetrical complications. Acute DIC carries a grim prognosis, with some studies showing a 28-day mortality rate ranging from 25% to 50%, which is significantly higher compared to critically ill hospitalized patients that do not fulfill the criteria of DIC. Since DIC is driven by an underlying trigger, the treatment relies on management of the inciting condition, with supportive measures aimed at repleting the coagulation proteins.