Key Takeaways

Disseminated intravascular coagulation (DIC) is not a disease; it always occurs as a complication of an underlying condition.

Not all DIC is the same. Some patients manifest primarily as extensive microvascular clot (organ failure), others as hemorrhage.

There is no single diagnostic test for DIC as there is for certain hematological disorders such as TTP (ADMATSD13 activity) or iron deficiency (ferritin). Clinical practice guidelines encourage the use of clinical scoring systems (as distinct from gestalt) to make the diagnosis of DIC.

Most scoring systems consider 4 lab parameters: fibrinogen, D-dimers/FDPs, platelet count and prothrombin time.

Repeat labs frequently since DIC is a highly dynamic process.

Treatment of DIC includes a three-pronged approach: 1) treatment of the underlying precipitating condition, 2) replacement therapy (platelet transfusion, fresh frozen plasma and cryoprecipitate or fibrinogen concentrate), and 3) inhibition of thrombin generation (with heparin and in rare cases protein C and/or antithrombin).

Replacement therapy should not be guided by lab results, but rather by the clinical situation, namely active bleeding or an increased risk of bleeding.

Use of heparin may be considered in cases of DIC associated with multiple organ failure, though there is no strong supportive evidence for its use in this setting.

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