Editorial Views  |   September 2019
Maintaining Hemostatic Balance in Treating Disseminated Intravascular Coagulation
Author Notes
  • From the Joint Department of Biomedical Engineering and the Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, (A.C.B.); and the Duke University School of Medicine, Department of Anesthesiology and Critical Care, Durham, North Carolina (J.H.L.).
  • This editorial accompanies the article on p. 543.
    This editorial accompanies the article on p. 543.×
  • For a downloadable PPT slide containing this article’s citation information, please visit https://anesthesiology.pubs.asahq.org/ss/downloadable_slide.aspx.
    For a downloadable PPT slide containing this article’s citation information, please visit https://anesthesiology.pubs.asahq.org/ss/downloadable_slide.aspx.×
  • Accepted for publication May 28, 2019.
    Accepted for publication May 28, 2019.×
  • Address correspondence to Dr. Brown: aecarso2@ncsu.edu
Article Information
Editorial Views / Coagulation and Transfusion / Hematologic System
Editorial Views   |   September 2019
Maintaining Hemostatic Balance in Treating Disseminated Intravascular Coagulation
Anesthesiology 9 2019, Vol.131, 459-461. doi:10.1097/ALN.0000000000002862
Anesthesiology 9 2019, Vol.131, 459-461. doi:10.1097/ALN.0000000000002862
Disseminated intravascular coagulation (DIC) is a complex coagulopathic state that can present as a thromboinflammatory response to diverse causes that include septic shock, traumatic injury, pregnancy, and cancer.1,2  The International Society on Thrombosis and Hemostasis (Carrboro, North Carolina) defines DIC as “an acquired syndrome characterized by the intravascular activation of coagulation with loss of localization arising from different causes that can originate from and cause damage to the microvasculature, which if sufficiently severe, can produce organ dysfunction.”3  In DIC, endothelial injury and microcirculatory abnormalities produced by hemostatic abnormalities cause multiorgan failure.4  Of note is that DIC is not a primary disease state, but rather a pathophysiologic response to an underlying disease process, and is based on laboratory diagnosis. The clinical (phenotypic) manifestations can range as a spectrum of either bleeding or thrombotic manifestation due to causes that include the underlying disease process (e.g., cancer-induced DIC), or the time course of diagnosis and therapy.2  The basis of therapy for DIC is to treat the underlying disease, but also provide temporary support of the coagulation disorder and coagulopathy that depends on whether patients present with bleeding or thrombotic phenotypes. The complexity of managing DIC is to balance both the bleeding and thrombotic complications that occur.