History of Disseminated Intravascular Coagulation (DIC) Research and My Personal Research History.

Disseminated intravascular coagulation (DIC) is like a cloud. We really can see it, but we never feel or touch it. This means that we can diagnose it, but we still do not know how that happens and how to manage it. DIC was first recognized as an uncontrollable bleeding disorder complicated by critical diseases. Curiously, despite such bleeding tendency, pathological examination revealed systemic micro-clot formation in multiple organs. Soon after, these specific findings were revealed as the result of excess coagulation followed by consumptive coagulopathy. Numerous factors, such as imbalanced coagulation/fibrinolysis, endothelial damage, platelet activation, and intravascular inflammation, are involved in the pathogenesis. However, the whole story has not been clarified yet, and DIC is also recognized as "Disseminated Intracerebral Confusion." In nearly 40 years, several diagnostic criteria were proposed but never integrated. As for the sepsis-associated DIC, the International Society on Thrombosis and Haemostasis recommended a two-step approach by Sepsis-Induced Coagulopathy (SIC) followed by overt DIC criteria. In this approach, the early (compensated)-phase is diagnosed by SIC, and the late (decompensated)-phase is diagnosed by overt DIC criteria. Regarding treatment, we are very sorry, but only the treatment for underlying conditions is recommended. However, aggressive anticoagulant therapies for early-phase DIC have been explored in Japan. We expect the effects of anticoagulant therapy to be proven in the near future.