pathogenesis
Last reviewed 01/2018
Disseminated intravascular coagulation (DIC) can only occur when a prothrombotic stimulus overwhelms the normal regulation of the coagulation cascade.
DIC is most commonly initiated by a mixture of two insults:
- endothelial damage:
- normal endothelium accumulates antithrombin and thrombomodulin and prevents thrombosis
- damage to endothelium exposes collagen and sources of tissue factor which stimulate thrombosis
- pathological release of tissue factor:
- sources include massive tissue damage, leukaemic cells, amniotic fluid embolism, cancers
Snake bites are a rare but often catastrophic cause of DIC; some venoms act by directly activating coagulation complexes e.g. prothrombinase and thrombin.