Bleeding associated with disseminated intravascular coagulation

Disseminated intravascular coagulation (DIC) is a clinicopathological syndrome in which an underlying acute or chronic illness or injury causes systemic activation of coagulation and consumption of platelets, coagulation factors, and their regulators, leading to microvascular thrombi, organ dysfunction, and hyperfibrinolysis. Depending upon the severity and tempo of the initiating event, DIC may be asymptomatic or cause severe thrombotic or hemorrhagic complications including death. The primary driver of DIC in most conditions is tissue factor pathway activation of thrombin, although many complex cellular and activation pathways are also involved. Conditions in which bleeding is a dominant complication of DIC will be a focus of this chapter.