Disseminated intravascular coagulation in palliative care

Disseminated intravascular coagulation is the result of consumption of the components of the clotting system when the clotting process is activated. This leads to the combined problems of bleeding and thrombosis. Disseminated intravascular coagulation is often multifactorial and usually occurs in patients with sepsis or metastatic cancer, or following chemotherapy. It has a very poor prognosis and is often a terminal event, even when treated.

Management of disseminated intravascular coagulation depends on the cause, potential benefits and burdens of investigations and treatment, and the patient’s prognosis, goals of care and preferences—see Emergencies in palliative care.

If active treatment is appropriate, transfer the patient to hospital urgently and seek specialist haematological advice.

If active treatment is not undertaken, focus on comfort care and symptom management; see Principles of care in the last days of life.