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Hematology & OncologyDiagnostic

Disseminated Intravascular Coagulation (ISTH 2025)

Disseminated Intravascular Coagulation (ISTH 2025): Suspected DIC → Underlying Disorder Present? → DIC Unlikely.

Pathway Overview

14 steps

Algorithm Steps

14 total

  1. 01Start

    Suspected DIC

    Patient with underlying condition and signs of coagulopathy

  2. 02Decision

    Underlying Disorder Present?

    DIC requires an inciting cause

    • Sepsis/severe infection
    • Trauma/surgery
    • Malignancy (especially APL)
    • Obstetric complications
    • Vascular abnormalities
    • Severe toxic/immunologic reactions
  3. 03Outcome

    DIC Unlikely

    Consider alternative diagnoses

    • TTP/HUS
    • Liver disease
    • Primary fibrinolysis
    • Heparin effect
  4. 04Action

    Calculate ISTH DIC Score

    Sum points from 4 parameters

    • Platelet count: >100=0, 50-100=1, <50=2
    • D-dimer: Normal=0, Moderate↑=2, Strong↑=3
    • Prolonged PT: <3s=0, 3-6s=1, >6s=2
    • Fibrinogen: >1.0g/L=0, <1.0g/L=1
  5. 05Decision

    ISTH DIC Score Result

    Interpret total score

  6. 06Action

    Score <5: Non-Overt DIC

    May be early or compensated DIC

    • Repeat scoring daily
    • Treat underlying cause aggressively
    • Monitor for progression
    • Consider prophylactic anticoagulation if indicated
  7. 07Action

    Serial Monitoring

    Repeat DIC score every 12-24 hours

    • CBC with platelets
    • PT/PTT
    • Fibrinogen
    • D-dimer
    • Clinical reassessment
  8. 08Outcome

    DIC Resolving

    Score decreasing, clinical improvement

  9. 09Outcome

    DIC Ongoing

    Reassess treatment, consider specialist consult

  10. 10Warning

    Score ≥5: Overt DIC

    Confirmed DIC - initiate treatment

  11. 11Action

    Treat Underlying Cause

    Cornerstone of DIC management

    • Antibiotics for sepsis
    • Surgical debridement if needed
    • Delivery for obstetric DIC
    • Chemotherapy for APL (with ATRA)
    • Supportive care
  12. 12Decision

    Predominant Phenotype?

    Bleeding vs thrombotic manifestations

  13. 13Action

    Bleeding Predominant

    Replacement therapy

    • Platelets if <20 or <50 with bleeding
    • FFP if PT/PTT prolonged with bleeding
    • Cryoprecipitate if fibrinogen <1.5 g/L
    • Tranexamic acid may be considered
    • Avoid heparin typically
  14. Path rejoins step 07Shared downstream outcome
  15. 14Action

    Thrombosis Predominant

    Consider anticoagulation

    • UFH or LMWH if no contraindication
    • Lower prophylactic doses typically
    • Balance bleeding risk
    • Protein C concentrate in severe sepsis (purpura fulminans)
  16. Path rejoins step 07Shared downstream outcome

Guideline Source

Updated definition and scoring of disseminated intravascular coagulation in 2025: ISTH SSC Subcommittee on DIC

DOI: 10.1016/j.jtha.2025.03.038View Guideline

Clinical Safety Information

Clinical Decision Support — Not a Substitute for Clinical Judgment

Individual patient factors may require deviation from these recommendations.

Known Limitations

  • Scoring system requires laboratory values that may not be immediately available
  • Does not replace clinical judgment for treatment decisions
  • Underlying cause treatment is the cornerstone - not addressed in detail
  • May need adaptation for specific populations (liver disease, pregnancy)

Applicable Regions

USEUGlobal

Global: ISTH scoring system is internationally recognized

Version 1Next review: 2028-01-01

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Frequently Asked Questions

What is the Disseminated Intravascular Coagulation (ISTH 2025)?

The Disseminated Intravascular Coagulation (ISTH 2025) is a diagnostic clinical algorithm for Hematology & Oncology. It provides a structured decision tree to guide clinical decision-making, based on Updated definition and scoring of disseminated intravascular coagulation in 2025: ISTH SSC Subcommittee on DIC.

What guideline is the Disseminated Intravascular Coagulation (ISTH 2025) based on?

This algorithm is based on Updated definition and scoring of disseminated intravascular coagulation in 2025: ISTH SSC Subcommittee on DIC (DOI: 10.1016/j.jtha.2025.03.038).

What are the limitations of the Disseminated Intravascular Coagulation (ISTH 2025)?

Known limitations include: Scoring system requires laboratory values that may not be immediately available; Does not replace clinical judgment for treatment decisions; Underlying cause treatment is the cornerstone - not addressed in detail; May need adaptation for specific populations (liver disease, pregnancy). Individual patient factors may require deviation from these recommendations.

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