Abstract
Cancer often leads to the activation of coagulation, manifesting as disseminated intravascular
coagulation (DIC) in its most extreme form. DIC is characterized by systemic intravascular
coagulation activation (leading to deposition of intravascular platelets and fibrin)
and simultaneous consumption of coagulation proteins and thrombocytes (which may cause
bleeding complications). The clinical course of DIC in patients with malignancies
is typically less intense compared with DIC complicating alternative clinical settings,
including systemic inflammatory responses following infection or traumatic injury.
A more slowly proceeding, less fulminant, and widespread hemostatic derangement can
remain asymptomatic. Eventually, the ongoing consumption may result in low levels
of platelets and coagulation factors, and bleeding complications (frequently localized
at the site of the tumor or distant metastases) may be the first clinical manifestation
of DIC. An alternative clinical scenario is dominated by thrombotic complications,
ranging from clinically manifest vascular thrombosis to microvascular platelet plugs.
The main principle of DIC management is adequate treatment of the precipitating disorder;
however, there are clinical presentations that may require additional supportive strategies
specifically aimed at the amelioration of the coagulopathy.
Keywords
disseminated intravascular coagulation - hemorrhage - thrombosis - thrombotic microangiopathy
- cancer - coagulation - fibrinolysis
