Disseminated Intravascular Coagulopathy

Disseminated intravascular coagulopathy is a consequence of dysregulated coagulation. The most common triggers are burns, sepsis, malignancy, and pregnancy. Activation and consumption of coagulation components can lead to microvascular thrombosis and end-organ injury. Diagnosis can be aided by utilizing a five-step scoring algorithm developed by the International Society on Thrombosis and Hemostasis. While some patients manifest a bleeding diathesis, others exhibit excessive thrombosis. Appropriate management of the underlying condition typically leads to resolution of the syndrome; however, blood product support is often necessary. Transfusion therapy should be guided by the clinical presentation and may include fresh frozen plasma, cryoprecipitate, and platelet concentrates. In the setting of disproportionate thrombosis, heparin therapy may be utilized to disrupt coagulation activation. In some cases of excessive fibrinolysis, antifibrinolytic agents may be useful. Anticoagulant factor concentrates are promising, but randomized clinical trial evidence is still needed to prove efficacy.