Disseminated Intravascular Coagulation (DIC) in Cancer

Recombinant human soluble thrombomodulin (thrombomodulin alfa) to treat disseminated intravascular coagulation in solid tumors: results of a one-arm prospective trial

“…permeability-enhancing factors) released by tumor cells [2]. An excess of such factors can activate coagulation pathways and result in persistent consumption of platelets and coagulation factors as well as increased fibrinolysis, leading to DIC and visceral dysfunction.…”

Safety of plasma‐derived protein C for treating disseminated intravascular coagulation in adult patients with active cancer

“…Less is known regarding the correlation between active cancer and coagulation consumption leading to DIC in patients without signs or symptom of sepsis [10][11][12][13]. As the presenting condition, DIC occurs in 2-5% of patients suffering from solid neoplasm [10].…”

“…Many factors can contribute to coagulopathy in tumors. Cancer cells express different procoagulant molecules as well as fibrinolytic proteins [10][11][12][13], and chemotherapy may enhance the risk of thrombosis due to its damaging effect on the endothelium [11]. Some clinical differences exist between the coagulopathy that occurs in sepsis in comparison to the one occurring in cancer.…”

“…In general, a less severe picture occurs in cancer patients where chronic activation of coagulation can proceed with few clinical events. This process usually leads to exhaustion of platelets and coagulation factors, thus making bleeding (e.g., at the site of the tumour) the first clinical symptom of DIC, while in other cases, cancerrelated coagulopathy occurs in the form of thrombotic microangiopathies [10][11][12][13]. In cancer-related DIC, conventional treatment is related to high mortality also due to the difficulty in properly treating the underlying neoplasm [10].…”

“…In fact, this complication, although rare, is extremely severe and difficult to treat properly [10,13,17]. Based on the notion that depression of the PC system may contribute significantly to the beginning of DIC in cancer patients, supplementation of PC may be of benefit [1,2,10,12]. However, the role of restoring defective physiological anticoagulant in patients with cancer has not been evaluated and extrapolation from other settings of patients is difficult; this is considering that patients with severe thrombocytopenia (as commonly occurs during cancer treatment) were excluded from the available trials for the use of ar-PC [9].…”