Clinical characteristics of disseminated intravascular coagulation in patients with solid and hematological cancers.

Malignant disease can be complicated by disseminated intravascular coagulation (DIC). DIC is defined as systemic intravascular triggering of coagulation (resulting in intravascular fibrin clot formation) and concurrent depletion of clotting factors and platelets (increasing the risk of hemorrhage). The clinical presentation of DIC in patients with cancer has usually a less fulminant presentation than DIC that may accompany other underlying disorders, such as sepsis and trauma. A more insidious, but also more protracted, diffuse activation of coagulation can proceed without any symptom. Ultimately this may lead to deficiency of platelets and clotting factors and hemorrhage (often at the site of the tumor or metastases) may be the first clinical symptom indicating the presence of DIC. An alternative presentation may be thrombosis, ranging from overt venous thrombo-embolism to microvascular disease and thrombotic microangiopathy. The therapeutic foundation of DIC is management of the underlying condition but in some cases supportive interventions, specifically targeting the hemostatic system may be needed.