Disseminated Intravascular Coagulation: Experience in a Major Cancer Center

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Abstract
Disseminated intravascular coagulation (DIC) developed in 89 patients seen at Memorial Sloan-Kettering Cancer Center between 1971 and 1974. Criteria for the diagnosis of DIC wore: 1. Hypofibrinogenemia or > 50% reduction in plasma fibrinogen on serial determinations. 2. Prolonged thrombin time and/or elevated titer of fibrinogen-related material in the serum. 3. Thrombocytopenia not due to drugs or disease. Patients with severe liver disease or uremia were excluded. The patients included 19 with leukemia (17 acute), 3 with multiple myeloma, 15 with lymphoma, 46 with metastatic solid tumors (12 genitourinary, 10 lung, 9 breast, 8 gastrointestinal, 7 miscellaneous), 4 with vascular tumors, and 3 without tumor. Other conditions which might have precipitated or initiated DIC such as gramnegative sepsis (20 patients), mild liver impairment (31 patients), and mucin secreting tumors (4 patients), were also noted. Four patients with vascular tumors, two with leukemia, and one with vasculitis had markedly shortened fibrinogen survival. Bleeding occurred in 75% of the patients and was fatal in 36%. Thromboembolism occurred in 22.5%. Thirteen percent were asymptomatic. Treatment with heparin was helpful in only three of twenty patients. Eighty percent of the patients died within one to over 30 days of the onset of DIC. Post mortem evidence of DIC was present in 18 of 43 autopsies.Results of this study indicate that DIC is a frequent complication of a wide variety of tumors and that its occurrence causes morbidity and mortality in a significant number of patients. Treatment with heparin is of little help unless remission is induced and the precipitating factor(s) are reversed.

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