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Disseminated Intravascular Coagulation

Disseminated Intravascular Coagulation is a topic covered in the 5-Minute Emergency Consult.

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  • Normal coagulation: Series of local reactions among blood vessels, platelets, and clotting factors
  • Disseminated intravascular coagulation (DIC) is systemic activation of coagulation and fibrinolysis by some other primary disease process.
  • Coagulation system activation results in systemic circulation of thrombin and plasmin.
  • Role of thrombin in DIC:
    • Tissue factor/factor VIII(a) activate the extrinsic pathway, leads to thrombin formation.
    • Thrombin circulates and converts fibrinogen to fibrin monomer.
    • Fibrin monomer polymerizes into fibrin (clot) in the circulation.
    • Clots cause microvascular and macrovascular thrombosis with resultant peripheral ischemia and end organ damage.
    • Platelets become trapped in clot with resultant thrombocytopenia.
  • Role of plasmin in DIC:
    • Plasmin circulates systemically converting fibrinogen into fibrin degradation products (FDPs).
    • FDPs combine with fibrin monomers.
    • FDP-monomer complexes interfere with normal polymerization and impair hemostasis.
    • FDPs also interfere with platelet function.
  • Role of impaired anticoagulation in DIC.
    • Failure of physiologic anticoagulation is necessary for DIC to occur.
    • Antithrombin III, protein C system, and tissue factor pathway inhibitor all impaired.
  • Acute DIC—uncompensated form:
    • Clotting factors used more rapidly than body can replace them
    • Hemorrhage predominant clinical feature, which overshadows ongoing thrombosis
  • Chronic DIC—compensated form:
    • Body able to keep up with pace of clotting factor consumption
    • Thrombosis predominant clinical feature


  • Precipitated by many disease states
  • Complications of pregnancy:
    • Retained fetus
    • Amniotic fluid embolism
    • Placental abruption
    • Abortion
    • Eclampsia
    • HELLP syndrome
  • Sepsis:
    • Gram negative (endotoxin-mediated meningococcemia)
    • Gram positive (mucopolysaccharide-mediated)
    • Other microorganisms (e.g., viruses, parasites)
  • Trauma:
    • Crush injury
    • Severe burns
    • Severe head injury
    • Fat embolism
  • Malignancy:
    • Solid tumor or metastatic disease
    • Hematologic malignancy (e.g., leukemia)
  • Intravascular hemolysis:
    • Transfusion reactions
    • Massive transfusion
  • Organ destruction:
    • Severe pancreatitis
    • Severe hepatic failure
  • Vascular abnormalities:
    • Kasabach–Merritt syndrome
    • Large vascular aneurysm
  • Thrombocytopenia:
    • Thrombotic thrombocytopenic purpura
    • Idiopathic thrombocytopenic purpura
  • Miscellaneous:
    • Snake bites
    • Recreational drugs

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Rosen, Peter, et al., editors. "Disseminated Intravascular Coagulation." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation.
Disseminated Intravascular Coagulation. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation. Accessed April 26, 2019.
Disseminated Intravascular Coagulation. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation
Disseminated Intravascular Coagulation [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Disseminated Intravascular Coagulation ID - 307022 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307022/all/Disseminated_Intravascular_Coagulation PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -