Disseminated intravascular coagulation: old disease, new hope

doi:10.1136/bmj.327.7421.974

BMJ 2003;327:974-977 (25 October), doi:10.1136/bmj.327.7421.974

Clinical review

Disseminated intravascular coagulation: old disease, new hope

Cheng Hock Toh, reader and consultant in haematology¹, Michael Dennis, specialist registrar¹

¹ Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool L7 8XP

Correspondence to: C H Toh toh@liverpool.ac.uk

Disseminated intravascular coagulation has long been associatedwith increased mortality in patients with sepsis. An effectivetreatment is now available, and the authors of this review describehow improved understanding and earlier diagnosis could leadto targeted treatment and improved prognosis

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Introduction

Although the first clinical observations on disseminated intravascularcoagulation (DIC) were reported in the 19th century,¹ this conditionof widespread and disordered coagulation has probably afflictedmankind for as long as trauma and infection have beset us. Indeed,DIC is generally associated with an adverse outcome by mostclinicians, and its acronym has been synonymous with "deathis coming." However, a drug targeted at the coagulopathy ofsevere sepsis (activated protein C) has now emerged as the firstsuccessful treatment for the condition.² We provide an updatedoverview of DIC and how its onset may indicate the turning pointfrom which an adaptive response becomes maladaptive and potentiallyinjurious to the host. Precise laboratory definition of thisprocess could provide a therapeutic window in critical illnessthat may finally deliver an improved outcome.

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A systematic search of PubMed with the search term "disseminatedintravascular coagulation" and related keywords yielded 10 . . . [Full text of this article]

Definition

Epidemiology

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Clinical manifestation

Pathophysiology

Diagnosis

Treatment

Conclusion

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