Disseminated intravascular coagulation in cirrhosis

Hemorrhagic sequelae of liver disease were recognized and described over a century ago (1). Bleeding has been a common complication and a leading cause of death in patients with cirrhosis (2, 3). The coincidence of low clotting factor levels, hypofibrinogenemia and thrombo‐cytopenia has prompted many investigators to ask whether disseminated intravascular coagulation (DIC) plays a role in the pathogenesis of hemorrhage in these patients (4–16). Despite an abundance of published investigations addressing this question, however, establishing the diagnosis of DIC in an individual patient with cirrhosis continues to pose a challenge for the clinician. In an attempt to reconcile the theoretical and the practical, the present review of the role of DIC in cirrhosis will address: (i) normal coagulation and the role of the liver; (ii) coagulation defects identified in DIC and in cirrhosis; (iii) role of DIC in cirrhosis, and (iv) new approaches to this question from the research, as well as from clinical, laboratories. Although some of the new techniques are still being evaluated, preliminary results appear promising in facilitating identification of DIC patients with cirrhosis.