Disseminated Intravascular Coagulation (DIC) — Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

🎓 Want to practice? Do a case challenge with this pathway → (get a case, choose management step by step, scored).

Full pathway

1. [Decision] ISTH overt DIC score
   ISTH overt DIC score (requires a known predisposing illness)? (Requires a known predisposing illness (sepsis, trauma, malignancy, obstetric complications, heat stroke, severe immune reaction, APL). ISTH score: platelets (≥100k=0/50–100k=1/<50k=2) + fibrin marker D-dimer (no rise=0/moderate=2/strong=3) + PT prolongation (<3 s=0/3–6 s=1/>6 s=2) + fibrinogen (≥1 g/L=0/<1=1). ≥5 = overt DIC, reassess q12–24h. Progressively falling platelets is often earliest; a normal D-dimer essentially excludes it.)
   • ≥5 (overt DIC) → Overt DIC → treat cause + support
   • <5 (non-overt) → <5 (non-overt)
2. [End] <5 (non-overt)
   Does not exclude DIC; continue to find and control the underlying disease, serially monitor platelets/PT/fibrinogen/D-dimer and re-score q12–24h. Do not transfuse products on labs alone in a non-bleeding patient.
3. [End] Overt DIC → treat cause + support
   1) Treating the underlying cause is paramount (antimicrobials + source control for sepsis, deliver for obstetric causes, ATRA for APL — DIC will not resolve unless the trigger is controlled). 2) Blood products for bleeding/procedures rather than numbers alone: active bleeding or planned invasive procedure → platelets (target >50×10⁹ when bleeding), fresh frozen plasma (prolonged PT/APTT), cryoprecipitate/fibrinogen (fibrinogen <1.0–1.5 g/L). 3) A thrombotic phenotype (predominant thrombosis, no major bleeding) may warrant therapeutic heparin anticoagulation. 4) Generally avoid tranexamic acid (unless marked hyperfibrinolysis such as APL/trauma). Monitor and re-score serially.

Source guidelines & references

• ISTH overt DIC score (Taylor FB, 2001); DIC management (EMCrit IBCC)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

Other pathways