Peer-review started: September 1, 2016
First decision: October 26, 2016
Revised: November 18, 2016
Accepted: December 16, 2016
Article in press: December 19, 2016
Published online: February 6, 2017
Disseminated intravascular coagulation (DIC) is a syndrome characterized by the systemic activation of blood clotting, which generates large amount of intravascular thrombin and fibrin. Various diseases may cause acceleration of the clotting cascade, inactivate the endogenous anticoagulants and modify fibrinolysis, having thus the formation of micro thrombi in the systemic circulation. The abnormalities in the hemostatic system in patients with DIC result from the sum of pathways that generate both hypercoagulability and augmented fibrinolysis. When the hypercoagulability state prevails, the main manifestation is organic failure. This subtype of DIC is often referred as “organ impairment” type, frequently seen in patients suffering from severe sepsis. To identify the underlying infection, early initiation of culture-based antimicrobial treatment, and to resolve any infection source promptly are keystone actions of DIC related to sepsis prevention and treatment. These should be combined with specific treatment related to each DIC subtype. In the context of septic shock, DIC is associated to increased severity, greater number and seriousness of organ failures, more frequent side-effects from treatment itself, and worse outcomes. Therefore, we ought to review the information available in the literature about approach and management of DIC in severe sepsis.
Core tip: Disseminated intravascular coagulation (DIC) is a syndrome characterized by the systemic activation of blood clotting, which generates large amount of intravascular thrombin and fibrin. In the context of severe sepsis and septic shock, DIC is related to increased severity, greater number and seriousness of organ failures, more frequent side-effects from treatment itself, and worse outcomes. We ought to review the most important and updated information available in the literature about DIC in severe sepsis and septic shock.