Learning objectives

• Recognize Disseminated Intravascular Coagulation (DIC)
• Management of DIC

Definition and mechanisms

• Disseminated Intravascular Coagulation is a life-threatening disease characterized by systemic activation of blood coagulation
• Resulting in the generation and deposition of fibrin
• Leading to microvascular thrombi in various organs and contributing to multiple organ dysfunction syndrome (MODS)
• Consumption of clotting factors and platelets in DIC can result in life-threatening hemorrhage
• Hence, a patient with DIC can present with a simultaneously occurring thrombotic and bleeding problem, obviously complicating the proper treatment
• DIC affects about 10% of very ill patients with sepsis, cancer, or pancreatitis or patients recovering from traumatic injuries such as burns or serious complications from pregnancy and delivery

Signs and symptoms

• Bleeding at wound sites or from the nose, gums, or mouth
• Blood in the stool or urine
• Bruising 
• Chest pain
• Pain, redness, warmth, and swelling of the leg
• Confusion, memory loss, or change of behavior
• Difficulty breathing
• Fever

Causes

Complications

• Acute respiratory distress syndrome (ARDS)
• Bleeding in the gastrointestinal tract
• Heart attack
• Shock
• Stroke
• Venous thromboembolism

Diagnosis

Management

Suggested reading

• Thachil J. Disseminated Intravascular Coagulation: A Practical Approach. Anesthesiology. 2016;125(1):230-236.
• Ridley, S., Taylor, B., Gunning, K., 2007. Medical management of bleeding in critically ill patients. Continuing Education in Anaesthesia Critical Care & Pain 7, 116–121.

Clinical updates

Scarlatescu E et al. (Anesthesiology, 2024) provide an updated framework describing DIC as a dynamic imbalance between coagulation activation and fibrinolysis, varying by clinical context (sepsis, trauma, obstetrics). The review highlights that sepsis-associated DIC is typically characterized by suppressed fibrinolysis and microvascular thrombosis (with SIC and ISTH scores aiding early detection), whereas trauma-related DIC often presents with early hyperfibrinolysis requiring targeted hemostatic resuscitation (e.g., tranexamic acid, viscoelastic-guided transfusion).

• Read more about this study HERE.

Deshpande et al. (Anesthesiology, 2025) highlight that malignancy-associated coagulopathy represents a major driver of disseminated intravascular coagulation (DIC), occurring in up to 10% of solid tumors and 20% of hematologic cancers. Tumor-mediated tissue factor overexpression, procoagulant microparticles, and neutrophil extracellular traps promote systemic coagulation activation, resulting in a spectrum ranging from subclinical hypercoagulability to overt DIC with both thrombosis and bleeding. 

• Read more about this study HERE.