DIC Update

On Monday, June 23, Ecaterina (Katy) Scarlatescu, MD, PhD, Department of Anaesthesia and Intensive Care, Fundeni Clinical Institute, University of Medicine and Pharmacy, Bucharest, Romania, chaired a plenary session of panelists at the ISTH annual meeting in Washington, DC, USA. The panel discussed the 2025 ISTH DIC definition and diagnostic guidelines we reported on June 6, 2025. Here is the task force’s recommended definition, updated from the 2001 definition:

“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.” 

The guidelines delineate thrombosis versus hemorrhagic DIC and provide these categories:

Overt DIC: a severe, clinically evident form of hemostatic derangement characterized by widespread activation of coagulation and dysregulated fibrinolysis, manifested by organ failure and/or bleeding tendency. It leads to excessive thrombosis and an increased risk of bleeding. In overt DIC, the regulatory mechanisms are overwhelmed, resulting in the consumption of coagulation factors and platelets, bleeding, and/or organ dysfunction. (Added: clinical manifestation assessment uses the SOFA score, a composite measure of respiratory, cardiovascular, hepatic, and renal failure.) D-dimer elevation cutoffs are the key update; a D-dimer of >7X the upper reference limit yields a score of 3, a D-dimer of >3X the upper reference limit yields a score of 2. Once named “consumptive coagulopathy.”

“Early Phase DIC” updates and encompasses the current terms, non-overt DIC, compensated DIC, sub-clinical DIC, and chronic DIC. In Early Phase DIC, organ involvement may not be evident; thus the diagnosis may rely on laboratory indications. Early Phase DIC overlaps with SIC indications.

Pre-DIC means the patient has DIC risk factors without organ involvement and with ambiguous laboratory indications. We solicit comments from the panelists and clinicians who deal with DIC regularly.