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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.

Last reviewed 01/2018