Updated definition and scoring of disseminated intravascular coagulation in 2025: communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation

Abstract

Compelling evidence supports the need to update the 2001 definition and diagnosis of disseminated intravascular coagulation (DIC) to reflect our current understanding of disease pathophysiology. DIC has been long considered a critical and untreatable sequela of various underlying causes, with resolution only after treatment of the eliciting etiology. Recent views have evolved to appreciate that DIC-associated mortality may be reduced by detection and treatment at an early stage. The International Society on Thrombosis and Haemostasis Scientific and Standardization Committee on DIC proposes an updated definition of DIC: "an acquired, life-threatening intravascular disorder characterized by systemic coagulation activation, dysregulated fibrinolysis, and endothelial injury, resulting in microthrombosis. DIC arises from various underlying etiologies and progresses from a potentially asymptomatic early phase to an advanced phase with hemorrhage and/or organ dysfunction." In accordance with this more comprehensive definition, we propose to establish more tailored diagnostic criteria that detect early-phase DIC based on the underlying disease. We also propose a modification to overt DIC diagnostic criteria and scoring for late-phase DIC. These consensus-driven modifications reflect knowledge obtained since the original 2001 definition, which advanced clinical practice and research on DIC. This revised framework is anticipated to foster more precise and earlier diagnoses, improve patient stratification in clinical studies, and facilitate the development of targeted therapies dependent on pathophysiological context.

Keywords: bleeding; capillary endothelial cell; disseminated intravascular coagulation; fibrinolysis; organ dysfunction syndrome.