Clinical Manifestations and Diagnosis of DIC

Abstract

Disseminated intravascular coagulation (DIC) is a frequent manifestation of severe underlying diseases such as sepsis, polytrauma or malignancy. The clinical presentation of DIC is variable and ranges from increases tendency to bleed to overt bleeding on the one hand, and from evidence of multi organ ischemia to major thromboembolic disease on the other hand. In general, the presence of DIC indicates a worse outcome of disease, than its absence in the same underlying disorder, but a direct causal association between DIC and clinical outcome remains uncertain. In the absence of a gold standard the diagnosis of DIC is complicated, and is based on a combination of an appropriate clinical entity and laboratory markers of deranged clotting. The latter include prolonged clotting times (APTT, PT), and reduced levels of fibrinogen and platelets, and if available an abnormal test for activated clotting such as fibrin degradation products. Treatment of DIC consists of effective treatment of the underlying disorder. In addition, measures should be taken to counteract bleeding by administering plasma and platelets if necessary. Low dose heparin infusion can be utilized to diminish DIC, but its use is hardly evidence based. Current studies investigate the potential efficacy of antithrombin and protein C concentrates, preliminary data suggest that these inhibitors may indeed favorably alter clinical outcome in DIC. Newer anticoagulants such as hirudin and inhibitors of the tissue factor pathway are under clinical investigation.