Haematology, coagulation and transfusion

Disseminated intravascular coagulation

Reviewed Nov 2026·3 references
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Score DIC (ISTH) and sepsis-induced coagulopathy, treat the cause, and give products only for bleeding or procedures.

Definition
DIC is an acquired syndrome of systemic intravascular coagulation activation causing microvascular thrombosis and consumption of platelets and factors. Causes: sepsis, trauma, obstetric (abruption, AFE), malignancy (APML), severe pancreatitis, snakebite (venom-induced consumption coagulopathy in India).

At the bedside

  1. 1

    Score

    ISTH overt DIC score ≥ 5 (platelets, D-dimer, PT, fibrinogen); in sepsis, SIC score ≥ 4 identifies earlier coagulopathy. Repeat daily: trends matter.

  2. 2

    Treat the cause

    Source control and antibiotics in sepsis; delivery in obstetric DIC; ATRA for APML; antivenom for snakebite coagulopathy.

  3. 3

    Bleeding or procedure

    Platelets if < 50 × 10⁹/L and bleeding; FFP 15-30 mL/kg if PT/aPTT > 1.5× with bleeding; fibrinogen < 150 mg/dL with bleeding: cryoprecipitate.

  4. 4

    No bleeding

    Platelets only if < 10-20 × 10⁹/L; do not give FFP for lab values alone.

  5. 5

    Thrombosis-predominant

    Therapeutic heparin in DIC with thrombosis (e.g. purpura fulminans, solid tumour) if not bleeding; VTE prophylaxis in all non-bleeding DIC.

  6. 6

    Antifibrinolytics

    Generally avoid TXA in sepsis-DIC; consider in hyperfibrinolytic DIC (APML, trauma, some obstetric).

ISTH overt DIC score (with an underlying cause)

ParameterPoints
Platelets > 100 × 10⁹/L0
Platelets 50-1001
Platelets < 502
D-dimer/FDP no increase0
Moderate increase2
Strong increase3
PT prolonged < 3 s0
PT prolonged 3-6 s1
PT prolonged > 6 s2
Fibrinogen > 100 mg/dL0
Fibrinogen ≤ 100 mg/dL1

Score ≥ 5 = overt DIC (repeat daily); < 5 suggests non-overt DIC (repeat in 1-2 days). D-dimer cut-offs depend on local assay.

Sepsis-induced coagulopathy (SIC) score

Parameter1 point2 points
PT-INR> 1.2> 1.4
Platelets (× 10⁹/L)100-149< 100
SOFA (respiratory, cardiovascular, hepatic, renal sum)1≥ 2

SIC ≥ 4 (with platelet + INR total > 2).

Red flag · call your senior now
Purpura fulminans (meningococcal sepsis): rapidly progressive skin necrosis with DIC - early antibiotics, products, consider protein C concentrate.
Pitfall
Treating DIC numbers with products in a non-bleeding patient.
Pitfall
Relying on a single normal fibrinogen: it is an acute-phase reactant and may fall only late in sepsis.
Pearl
APML presents with profound hyperfibrinolytic DIC: start ATRA on suspicion and keep fibrinogen > 150 mg/dL and platelets > 30-50.

References

  1. 1

    Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost 2001;86:1327-30.

  2. 2

    Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of DIC from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013;11:761-7.

  3. 3

    Iba T, Nisio MD, Levy JH, Kitamura N, Thachil J. New criteria for sepsis-induced coagulopathy (SIC) following the revised sepsis definition: a retrospective analysis of a nationwide survey. BMJ Open 2017;7:e017046.

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