Disseminated Intravascular Coagulation: A Comprehensive Review Of Diagnostic Criteria, Biomarkers, And Management Strategies

Abstract

Introduction

Disseminated Intravascular Coagulation (DIC) is a life-threatening, systemic disorder marked by widespread activation of coagulation pathways, leading to concurrent thrombotic and hemorrhagic complications. Its diagnosis is complicated by variable clinical presentations and overlapping laboratory findings across different underlying conditions such as sepsis, trauma, cancer, and obstetric emergencies. While multiple scoring systems—such as ISTH, JAAM, and SIC—have been developed, their comparative accuracy and clinical utility remain inconsistent. This review aims to consolidate findings from over 30 recent studies to evaluate the diagnostic performance of these criteria, explore emerging biomarkers, and assess current therapeutic approaches.

Methodology:A systematic search of PubMed, Scopus, and Google Scholar was conducted for studies published between 2010 and 2025. Eligible studies included observational cohorts, systematic reviews, and meta-analyses focusing on DIC diagnosis, biomarkers, and treatment strategies. Inclusion criteria mandated clinical relevance, data on at least one scoring system or biomarker, and human subjects. Studies were grouped thematically into diagnostic, prognostic, and interventional domains.

Results:Analysis of 30+ studies revealed significant heterogeneity in the application and performance of diagnostic scoring systems. JAAM criteria were more sensitive in early DIC detection, particularly in sepsis and trauma, while ISTH scoring demonstrated higher specificity for overt DIC and mortality prediction. SIC scoring showed moderate performance and ease of use. Biomarkers such as D-dimer, fibrinogen, thrombomodulin, and PAI-1 were found to add prognostic value beyond traditional scoring systems. Therapeutic strategies remain largely supportive; however, evidence for selective anticoagulation and adjunctive therapies (e.g., antithrombin, recombinant thrombomodulin) shows promise in specific patient subsets, though randomized data are limited.

Conclusion:Despite advances in diagnostic scoring and biomarker identification, DIC remains a diagnostic and therapeutic challenge. Current tools vary in accuracy depending on the clinical setting, and there is no universally accepted treatment protocol. Future research should prioritize large-scale, prospective studies to validate composite diagnostic models and clarify the role of targeted therapies. An integrated approach combining clinical criteria, laboratory trends, and biomarker data may enhance early diagnosis and individualized care in DIC.