Disseminated intravascular coagulation

Abstract

Disseminated intravascular coagulation (DIC) is an acquired syndrome characterized by widespread intravascular activation of coagulation that can be caused by infectious insults (such as sepsis) and non-infectious insults (such as trauma). The main pathophysiological mechanisms of DIC are inflammatory cytokine-initiated activation of tissue factor-dependent coagulation, insufficient control of anticoagulant pathways and plasminogen activator inhibitor 1-mediated suppression of fibrinolysis. Together, these changes give rise to endothelial dysfunction and microvascular thrombosis, which can cause organ dysfunction and seriously affect patient prognosis. Recent observations have pointed to an important role for extracellular DNA and DNA-binding proteins, such as histones, in the pathogenesis of DIC. The International Society on Thrombosis and Haemostasis (ISTH) established a DIC diagnostic scoring system consisting of global haemostatic test parameters. This scoring system has now been well validated in diverse clinical settings. The theoretical cornerstone of DIC management is the specific and vigorous treatment of the underlying conditions, and DIC should be simultaneously managed to improve patient outcomes. The ISTH guidance for the treatment of DIC recommends treatment strategies that are based on current evidence. In this Primer, we provide an updated overview of the pathophysiology, diagnosis and management of DIC and discuss the future directions of basic and clinical research in this field.

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Figure 1: Schematic representation of coagulation physiology.
Figure 2: Interaction of inflammation and coagulation in DIC.
Figure 3: Diverse and opposing effects of thrombin.
Figure 4: Purpura fulminans in a patient with DIC due to meningococcal septicaemia.
Figure 5: Management strategies for DIC.
Figure 6: Anticoagulant factor concentrate treatment for DIC.

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Acknowledgements

C.-H.T. has received funding from the US National Institute of Health Research. The authors thank Y. Alhamdi (University of Liverpool, UK) for assistance in preparing the manuscript.

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Introduction (S.G.); Epidemiology (S.G.); Mechanisms/pathophysiology (C.-H.T. and M.L.); Diagnosis, screening and prevention (C.-H.T.); Management (S.G.); Quality of life (S.G.); Outlook (M.L.); Overview of Primer (S.G.).

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Correspondence to Satoshi Gando.

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Gando, S., Levi, M. & Toh, C. Disseminated intravascular coagulation. Nat Rev Dis Primers 2, 16037 (2016). https://doi.org/10.1038/nrdp.2016.37

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