• Clinical science

Disseminated intravascular coagulation


Disseminated intravascular coagulation (DIC) is a disorder characterized by systemic activation of the clotting cascade with microthrombi formation, platelet consumption, and subsequent exhaustion of all clotting factors. The most common causes of DIC include sepsis, trauma, and malignancy. Patients present with signs of bleeding (e.g., purpura, petechiae, ecchymoses) and/or multiorgan failure. Laboratory studies show thrombocytopenia, prolonged PT and aPTT, decreased fibrinogen levels, and increased D-dimer. Treatment involves identifying the underlying cause as well as supportive therapy with transfusions of platelet concentrates, FFP, and/or cryoprecipitate.


The mnemonic “STOP Making Trouble!”- helps recall the etiology of DIC. M - Malignancy, T - Transfusion, S - Sepsis/Snakebites, T - Trauma (acute traumatic coagulopathy), O - Obstetric complications, P - PancreatitisReferences:[1][2]


Types of DIC Bleeding (hyperfibrinolytic) type Organ-failure (thrombotic) type Massive bleeding (consumptive) type Non-symptomatic DIC
  • Cytokines → hypercoagulation with hypofibrinolysis → microthrombi → impaired perfusion and tissue necrosis
Common causes
  • Any cause of DIC
Clinical features
  • Bleeding
  • Massive hemorrhage
  • Asymptomatic

DIC is an acquired coagulopathy that is frequently seen in hospitalized individuals!References:[3][4]

Clinical features

The clinical features of DIC may appear acutely (e.g., following trauma, sepsis), or may appear subacutely (e.g., DIC following malignancy)!


Finding Type of DIC
Bleeding type Organ failure type Consumptive type Non-symptomatic type
Thrombocytopenia bleeding time
↑ Markers of fibrin breakdown (D-dimer, or FDP)


Fibrinogen levels × ×
Factor V and factor VIII ×




Hematocrit × × ×


× ×

The diagnosis of DIC is not based on a single marker but on a combination of laboratory findings! Thrombocytopenia, elevated D-dimer, increased PT and aPTT, and low fibrinogen should immediately raise suspicion for DIC!


Differential diagnoses

All coagulation factors would be decreased in patients with DIC!

The differential diagnoses listed here are not exhaustive.


Treatment of the underlying disease forms the cornerstone of the management of DIC!


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last updated 10/21/2020
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