Global practice and challenges in the diagnosis and management of disseminated intravascular coagulation: communication from the ISTH SSC Subcommittee on Disseminated Intravascular Coagulation.

BACKGROUND

Despite the global burden of disseminated intravascular coagulation (DIC) and decades of scoring system development, no international assessment has evaluated current global practices among clinicians.

OBJECTIVES

To describe international diagnostic and treatment practices for DIC, identify barriers, and examine differences across country income levels.

METHODS

The International Society on Thrombosis and Haemostasis (ISTH) Scientific Standardization Subcommittee on DIC conducted an international survey (March 2024 to February 2025) to assess global diagnostic and treatment practices. Analysis was stratified by country income level based on World Bank classifications.

RESULTS

A total of 153 clinicians from 27 countries completed the survey, with most respondents from high-income countries (64%). The most suggestive clinical features of DIC were bleeding (89%), petechiae (77%), and shock (63%). Standard laboratory tests, such as platelet count (93%), prothrombin time/international normalized ratio (85%), fibrinogen (78%), and D-dimer (76%), were commonly used; however, respondents from middle-income countries had reduced access to fibrinogen testing, serial monitoring, and advanced diagnostics. Only 28% of clinicians used a formal DIC scoring system (ISTH 21%; sepsis-induced coagulopathy 14%), despite 76% reporting familiarity with the ISTH definition. First-line management relied primarily on fresh-frozen plasma (65%), platelets (38%), and cryoprecipitate (32%), whereas middle-income clinicians more frequently used whole blood and less frequently specialized factor concentrates. Major challenges in the diagnosis and management of DIC included diagnostic uncertainty due to variable underlying disorders (59%) and a heterogeneous clinical presentation (47%). Resource limitations, including restricted laboratory testing (57%), inadequate transfusion supplies (54%), and insufficient critical care support (38%), were more frequent challenges in middle-income countries (P < .001 for all comparisons).

CONCLUSION

Despite strong global awareness, major gaps persist between recommended and real-world DIC practice, particularly in resource-limited settings. Efforts to expand access to diagnostics, strengthen transfusion and critical care networks, and support guideline-based management are needed.