eMedicine Specialties > Hematology > Coagulation, Hemostasis, and Disorders

Disseminated Intravascular Coagulation: Follow-up

Author: Marcel M Levi, MD, Chair, Department of Medicine, Division of Internal Specialists of the Academic Medical Center, University of Amsterdam, the Netherlands; Chair, Netherlands Society on Thrombosis and Hemostasis
Coauthor(s): Alvin H Schmaier, MD, Robert W Kellermeyer Professor of Hematology/Oncology, Case Western Reserve University School of Medicine; Chief, Division of Hematology/Oncology, Case Western Reserve University
Contributor Information and Disclosures

Updated: Oct 4, 2009

Follow-up

Further Inpatient Care

  • If unclear, a diagnostic workup in search of the underlying condition causing disseminated intravascular coagulation (DIC) should be initiated.

Complications

  • Death is the most serious complication in cases of disseminated intravascular coagulation (DIC).
  • Organ dysfunction and limb ischemia may occur.
  • Bleeding, which can be excessive, may seriously complicate the clinical course of a patient with disseminated intravascular coagulation (DIC).

Prognosis

  • The prognosis of disseminated intravascular coagulation (DIC) depends on the underlying disorder. If the underlying condition is self-limited or can be appropriately handled, the disseminated intravascular coagulation (DIC) will disappear, and the coagulation status will normalize.

Miscellaneous

Medicolegal Pitfalls

The following can lead to medicolegal pitfalls in cases of disseminated intravascular coagulation (DIC):

  • Failure to recognize the underlying etiology
  • Failure to understand that a good patient outcome is more dependent on the nature of the underlying etiology than on the disseminated intravascular coagulation (DIC) itself, such as the following:
    • A patient with acute hemorrhagic disseminated intravascular coagulation (DIC) that is associated with metastatic gastric carcinoma likely has a lethal condition, one that does not alter patient demise, regardless of treatment.
    • Alternatively, a patient with acute disseminated intravascular coagulation (DIC)associated with abruptio placenta needs quick recognition and obstetric treatment; the disseminated intravascular coagulation (DIC) resolves with the treatment of the obstetric catastrophe.

 


More on Disseminated Intravascular Coagulation

Overview: Disseminated Intravascular Coagulation
Differential Diagnoses & Workup: Disseminated Intravascular Coagulation
Treatment & Medication: Disseminated Intravascular Coagulation
Follow-up: Disseminated Intravascular Coagulation
Multimedia: Disseminated Intravascular Coagulation
References
Further Reading
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References

  1. Vincent JL, De Backer D. Does disseminated intravascular coagulation lead to multiple organ failure?. Crit Care Clin. Jul 2005;21(3):469-77. [Medline].

  2. Levi M, Ten Cate H. Disseminated intravascular coagulation. N Engl J Med. Aug 19 1999;341(8):586-92. [Medline].

  3. Levi M. The coagulant response in sepsis. Clin Chest Med. Dec 2008;29(4):627-42. [Medline].

  4. Leblebisatan G, Sasmaz I, Antmen B, et al. Management of life-threatening hemorrhages and unsafe interventions in nonhemophiliac children by recombinant factor VIIa. Clin Appl Thromb Hemost. Oct 6 2008;epub ahead of print. [Medline].

  5. Mesters RM, Mannucci PM, Coppola R, et al. Factor VIIa and antithrombin III activity during severe sepsis and septic shock in neutropenic patients. Blood. Aug 1 1996;88(3):881-6. [Medline]. [Full Text].

  6. Sawamura A, Hayakawa M, Gando S, Kubota N, Sugano M, Wada T, et al. Disseminated intravascular coagulation with a fibrinolytic phenotype at an early phase of trauma predicts mortality. Thromb Res. Aug 4 2009;[Medline].

  7. Sivula M, Pettilä V, Niemi TT, Varpula M, Kuitunen AH. Thromboelastometry in patients with severe sepsis and disseminated intravascular coagulation. Blood Coagul Fibrinolysis. Sep 2009;20(6):419-26. [Medline].

  8. Sawamura A, Hayakawa M, Gando S, Kubota N, Sugano M, Wada T, et al. Application of the Japanese Association for Acute Medicine disseminated intravascular coagulation diagnostic criteria for patients at an early phase of trauma. Thromb Res. Aug 1 2009;[Medline].

  9. Zhu YJ, Huang XK. Relationship between disseminated intravascular coagulation and levels of plasma thrombinogen segment 1+2, D-dimer, and thrombomodulin in patients with multiple injuries. Chin J Traumatol. Aug 2009;12(4):203-9. [Medline].

  10. Duchesne JC, Islam TM, Stuke L, Timmer JR, Barbeau JM, Marr AB, et al. Hemostatic resuscitation during surgery improves survival in patients with traumatic-induced coagulopathy. J Trauma. Jul 2009;67(1):33-7; discussion 37-9. [Medline].

  11. Takashima A, Shirao K, Hirashima Y, Takahari D, Okita NT, Nakajima TE, et al. Sequential chemotherapy with methotrexate and 5-fluorouracil for chemotherapy-naive advanced gastric cancer with disseminated intravascular coagulation at initial diagnosis. J Cancer Res Clin Oncol. Sep 2 2009;[Medline].

  12. Taylor FB Jr, Toh CH, Hoots WK, et al, for the Scientific Subcommittee on Disseminated Intravascular Coagulation (DIC) of the ISTH. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. Nov 2001;86(5):1327-30. [Medline]. [Full Text].

  13. Sawamura A, Gando S, Hayakawa M, et al. Effects of antithrombin III in patients with disseminated intravascular coagulation diagnosed by newly developed diagnostic criteria for critical illness. Clin Appl Thromb Hemost. Oct 7 2008;epub ahead of print. [Medline].

  14. Dhainaut JF, Yan SB, Joyce DE, et al. Treatment effects of drotrecogin alfa (activated) in patients with severe sepsis with or without overt disseminated intravascular coagulation. J Thromb Haemost. Nov 2004;2(11):1924-33. [Medline].

  15. Levi M. Current understanding of disseminated intravascular coagulation. Br J Haematol. Mar 2004;124(5):567-76. [Medline].

  16. Levi M. Disseminated intravascular coagulation: What's new?. Crit Care Clin. Jul 2005;21(3):449-67. [Medline].

  17. Schmaier AH. Disseminated intravascular coagulation – pathogenesis and management. J Intens Care Med. 1991;6:209-28.

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Further Reading

Related eMedicine Topics

Clinical Trial

 Clinical Guidelines

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Keywords

disseminated intravascular coagulation, bleeding, DIC, consumption coagulopathy, intravascular coagulation, thrombosis, thrombin, plasmin, consumptive coagulopathy, blood coagulation disorder

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Contributor Information and Disclosures

Author

Marcel M Levi, MD, Chair, Department of Medicine, Division of Internal Specialists of the Academic Medical Center, University of Amsterdam, the Netherlands; Chair, Netherlands Society on Thrombosis and Hemostasis
Marcel M Levi, MD is a member of the following medical societies: American Society of Hematology and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Coauthor(s)

Alvin H Schmaier, MD, Robert W Kellermeyer Professor of Hematology/Oncology, Case Western Reserve University School of Medicine; Chief, Division of Hematology/Oncology, Case Western Reserve University
Alvin H Schmaier, MD is a member of the following medical societies: American Federation for Medical Research, American Heart Association, American Society for Clinical Investigation, American Society of Hematology, Association of American Physicians, Central Society for Clinical Research, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Medical Editor

Pradyumna D Phatak, MBBS, MD,, Chair, Division of Hematology and Medical Oncology, Rochester General Hospital; Clinical Professor of Oncology, Roswell Park Cancer Institute
Pradyumna D Phatak, MBBS, MD, is a member of the following medical societies: American Society of Hematology
Disclosure: Novartis Honoraria Speaking and teaching

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Ronald A Sacher, MB, BCh, MD, FRCPC, Professor, Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center
Ronald A Sacher, MB, BCh, MD, FRCPC is a member of the following medical societies: American Society of Hematology
Disclosure: Glaxo Smith Kline Honoraria Speaking and teaching; Talecris Honoraria Board membership

CME Editor

Rajalaxmi McKenna, MD, FACP, Southwest Medical Consultants, SC, Department of Medicine, Good Samaritan Hospital, Advocate Health Systems
Rajalaxmi McKenna, MD, FACP is a member of the following medical societies: American Society of Clinical Oncology, American Society of Hematology, and International Society on Thrombosis and Haemostasis
Disclosure: Nothing to disclose.

Chief Editor

Emmanuel C Besa, MD, Professor, Department of Medicine, Division of Hematologic Malignancies, Kimmel Cancer Center, Thomas Jefferson University
Emmanuel C Besa, MD is a member of the following medical societies: American Association for Cancer Education, American College of Clinical Pharmacology, American Federation for Medical Research, American Society of Hematology, and New York Academy of Sciences
Disclosure: Nothing to disclose.

 
 
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