Clinical Review

Disseminated intravascular coagulation: old disease, new hope

BMJ 2003; 327 doi: 10.1136/bmj.327.7421.974 (Published 23 October 2003)
Cite this as: BMJ 2003;327:974

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  1. Cheng Hock Toh, reader and consultant in haematology (toh@liverpool.ac.uk)1,
  2. Michael Dennis, specialist registrar1
  1. 1Roald Dahl Haemostasis and Thrombosis Centre, Royal Liverpool University Hospital, Liverpool L7 8XP
  1. Correspondence to: C H Toh

    Disseminated intravascular coagulation has long been associated with increased mortality in patients with sepsis. An effective treatment is now available, and the authors of this review describe how improved understanding and earlier diagnosis could lead to targeted treatment and improved prognosis

    Introduction

    Although the first clinical observations on disseminated intravascular coagulation (DIC) were reported in the 19th century,1 this condition of widespread and disordered coagulation has probably afflicted mankind for as long as trauma and infection have beset us. Indeed, DIC is generally associated with an adverse outcome by most clinicians, and its acronym has been synonymous with “death is coming.” However, a drug targeted at the coagulopathy of severe sepsis (activated protein C) has now emerged as the first successful treatment for the condition.2 We provide an updated overview of DIC and how its onset may indicate the turning point from which an adaptive response becomes maladaptive and potentially injurious to the host. Precise laboratory definition of this process could provide a therapeutic window in critical illness that may finally deliver an improved outcome.

    Sources and selection criteria

    A systematic search of PubMed with the search term “disseminated intravascular coagulation” and related keywords yielded 10 262 publications, most of which related to pathophysiology and case reports. Owing to a lack of systematic controlled clinical trials, many recommendations are based on expert opinion and consensus driven guidelines rather than a secure evidence base. However, an increasing number of randomised controlled trials studying the diagnosis and management of DIC have been reported in the past five years, and we have incorporated these in the review.

    Definition

    DIC represents a continuum in clinical-pathological severity, characterised by the increasing loss of localisation or compensated control in intravascular activation of coagulation. It has definable phases that characterise patients at risk for increased mortality. The International Society of Thrombosis …

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