Recent acquisitions in the pathophysiology, diagnosis and treatment of disseminated intravascular coagulation

In this review, we briefly report the present knowledge about the pathophysiology and diagnosis of DIC. Particular attention is also given to the current standard and experimental therapies of overt DIC.Disseminated intravascular coagulation (DIC) is a disorder characterized by massive systemic intravascular activation of coagulation, leading to widespread deposition of fibrin in the circulation which can compromise the blood supply to various organs, thus contributing to multiple organ failure. At the same time, the consumption of platelets and coagulation proteins resulting from the ongoing coagulation may induce severe bleeding[1-6]. However, DIC is not a disease itself but is always secondary to an underlying disorder [7,8]. In fact, a variety of clinical conditions may cause systemic activation of coagulation. Table 1 lists the diseases most frequently associated with DIC. Bacterial infections, in particular septicemia, are the most common clinical conditions associated with DIC. There is no difference in the incidence of DIC in patients with Gram-negative or Gram-positive sepsis. Systemic infections by other micro-organisms, such as viruses and parasites, may also lead to DIC. The generalized activation of coagulation occurring in these cases is mediated by cell membrane components of micro-organisms (lipopolysaccharide or endotoxin) or bacterial exotoxins, such as staphylococcal α hemolysin, which cause a generalized inflammatory response through the activation of pro-inflammatory cytokines [9-13]. Severe trauma and burns are other conditions frequently associated with DIC [14,15]. Both solid and hematologic cancers may be associated with DIC, which can complicate up to 15 percent of cases of metastasized tumors or acute leukemia [16-18]. DIC is also a frequent complication (occurring in more than 50 percent of cases) of some obstetric conditions such as abruptio placentae and amniotic fluid embolism [19,20]. Finally, selected vascular disorders, such as gian