Disseminated intravascular coagulation

Disease Name Confirmation

Disseminated intravascular coagulation (DIC; diffuse or disseminated intravascular coagulation) is the medically accepted term. The information below is a summary combining the provided clinical information and general medical knowledge.

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1) Disease Description (Causes and Symptoms)

• Definition and pathophysiology
  • This is a condition in which the coagulation system is excessively activated within the blood vessels, causing widespread formation of microthrombi. As a result, platelets, coagulation factors, fibrinogen, and other substances are consumed, causing a tendency to bleed and tissue ischemia (organ ischemia) at the same time. When secondary fibrinolysis occurs, elevated FDP/D‑dimer levels may be observed.
• Main causes
  • Sepsis (bacteremia or viremia), major trauma or surgery, obstetric emergencies such as placental abruption, amniotic fluid embolism, and eclampsia, massive transfusion or hemolytic reactions, severe burns, advanced malignant tumors (e.g., stomach, lung, pancreatic, prostate, or breast cancer, hematologic cancers, etc.), giant hemangiomas, and others.
• Main symptoms
  • Bleeding: skin (petechiae, bruising), mucous membranes, bleeding at injection or blood-draw sites, gastrointestinal bleeding, etc.
  • Symptoms related to thrombosis and ischemia: frequent urination or anuria (renal ischemia), shortness of breath (pulmonary thrombosis or pulmonary ischemia), abdominal pain (intestinal ischemia), decreased consciousness or seizures (central nervous system ischemia), and peripheral cyanosis
  • Systemic: hypotensive shock, multiple organ failure

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2) Treatment Methods and Precautions

• Treatment principles
  1. Correct the underlying disease as quickly as possible, preferably as the first priority (e.g., antibiotic treatment for sepsis, obstetric management for placental abruption, and appropriate treatment for cancer).
  2. DIC itself is managed with adjunctive and supportive treatment (including hemodynamic and respiratory support).
• Medication and transfusion therapy (general recommendations)
  • Blood products
    • Platelet concentrates: for severe bleeding or when the platelet count is <50×10^9/L before surgery or an intervention (a higher threshold is recommended for severe cerebral hemorrhage, neurosurgery, etc.).
    • Fresh frozen plasma (FFP): when replacement of coagulation factors is needed (extensive coagulation factor deficiency or prolonged PT/aPTT).
    • Cryoprecipitate: to replace low fibrinogen (usually when fibrinogen is <1.5 g/L or when there is clinical bleeding).
  • Anticoagulants
    • Low-dose heparin (mainly considered for non-bleeding or thrombosis-predominant DIC). It is generally contraindicated when bleeding is the main problem.
    • The choice between low-molecular-weight heparin and unfractionated heparin is determined according to the patient's condition and bleeding risk.
  • Replacement therapy (specific situations)
    • Antithrombin (AT) concentrate: considered when AT reduction is severe and anticoagulation is needed (evidence is limited and caution is required).
    • Recombinant human thrombomodulin (rTM): used in some countries (e.g., Japan), with mixed evidence. Follow institutional guidelines.
  • Antifibrinolytic agents
    • Tranexamic acid and similar agents are generally not used for DIC as a whole. However, they may be considered cautiously in cases of clear hyperfibrinolysis (with severe bleeding), but they may increase the risk of thrombosis, so specialist judgment is required.
• Supportive treatment
  • Intensive-care-level hemodynamic, respiratory, and renal support (including fluids, vasodilators, mechanical ventilation, and hemodialysis).
  • Minimize invasive procedures (because of the risk of bleeding).
• Lifestyle management and precautions (self-care)
  • Report signs of bleeding (gum bleeding, blood in the urine, bruising, etc.) immediately.
  • Consult the attending physician regarding trauma, cuts, or dental procedures while receiving anticoagulant treatment.
  • Management of chronic underlying diseases (such as infections and cancer) and regular follow-up testing are recommended.
• Complications
  • Multiple organ failure, death due to severe bleeding, and thrombotic complications (such as pulmonary embolism).

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3) Checkpoints Before an Outpatient Visit (Including Items to Bring and Sample Questions)

• Items to bring
  • A list of currently used medications and supplements (including doses and administration times)
  • Past medical history (especially bleeding disorders, liver disease, malignant tumors, and recent surgery, trauma, or transfusion) and allergy information
  • Recent test results (if possible, CBC, PT/INR, aPTT, fibrinogen, D‑dimer/FDP, etc. from within the past 2 weeks)
  • A note summarizing when and where bleeding or thrombosis occurred and how severe it was
  • Whether pregnancy is possible (for women)
• Items to prepare in advance for the outpatient visit
  • The time of symptom onset and its progression (when it began and under what circumstances it worsened)
  • Fever or signs of infection, and whether there has been recent surgery, childbirth, or miscarriage
• Examples of questions to ask the doctor first during the outpatient visit (prepare them briefly)
  • “Based on my current test results, how do you assess my level of risk for DIC?”
  • “Can I continue taking the medications I am currently using (e.g., anticoagulants or antiplatelet agents)?”

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4) Examples of General Questions to Ask the Doctor

• “What do you think is the exact cause of this DIC?”
• “What additional tests or monitoring do I need?”
• “What emergency measures should I take if bleeding or thrombosis occurs?”
• “After treatment, which follow-up tests will be needed, and how often?”
• “How does the prognosis vary depending on the underlying disease?”

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5) Examples of Disease-Specific Questions

• For patients with cancer-related DIC:
  • “Is my current cancer having a major effect on DIC? How will the timing of starting or stopping cancer treatment be determined?”
• For patients with obstetric causes (e.g., placental abruption or amniotic fluid embolism):
  • “How will the delivery method or surgical treatment be determined to prevent DIC from worsening? How should I be monitored after delivery?”

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Note: Decisions regarding diagnosis and treatment are made by the attending physician after considering the individual patient's condition (the pattern of bleeding versus thrombosis, underlying diseases, test results, etc.). If you have emergency symptoms (severe bleeding, shock, sudden marked decrease in consciousness, etc.), go to the emergency room immediately or call 119/use the local emergency medical system.