Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

Asakura, Hidesaku; Takahashi, Hoyu; Uchiyama, Toshimasa; Eguchi, Yutaka; Okamoto, Kohji; Kawasugi, Kazuo; Madoiwa, Seiji; Wada, Hideo

doi:10.1186/s12959-016-0117-x

Thrombosis Journal

Table 4 JSTH’s provisional draft DIC diagnostic criteria

From: Proposal for new diagnostic criteria for DIC from the Japanese Society on Thrombosis and Hemostasis

Classification of type	Basic		Hematopoietic disorder		Infectious
Platelet count (×10⁴/μl)	>12	0 p			>12	0 p
	8< – ≤12	1 p			8< – ≤12	1 p
	5< – ≤8	2 p			5< – ≤8	2 p
	≤5	3 p			≤5	3 p
	≥30 % decrease w/in 24 h (*1)	+1 p			≥30 % decrease w/in 24 h (*1)	+1 p
FDP (μg/ml)	<10	0 p	<10	0 p	<10	0 p
	10≤ – <20	1 p	10≤ – <20	1 p	10 ≤ – <20	1 p
	20≤ – <40	2 p	20≤ -<40	2 p	20≤ – <40	2 p
	≥40	3 p	≥40	3 p	≥40	3 p
Fibrinogen (mg/dl)	>150	0 p	>150	0 p
	100< – ≤150	1 p	100< – ≤150	1 p
	≤100	2 p	≤100	2 p
Prothrombin time ratio	<1.25	0 p	<1.25	0 p	<1.25	0 p
	1.25≤ – <1.67	1 p	1.25≤ – <1.67	1 p	1.25≤ – <1.67	1 p
	≥1.67	2 p	≥1.67	2 p	≥1.67	2 p
Antithrombin (%)	>70	0 p	>70	0 p	>70	0 p
Antithrombin (%)	≤70	1 p	≤70	1 p	≤70	1 p
TAT, SF or F₁₊₂	<2-fold of normal upper limit	0 p	<2-fold of normal upper limit	0 p	<2-fold of normal upper limit	0 p
TAT, SF or F₁₊₂	≥2-fold of normal upper limit	1 p	≥2-fold of normal upper limit	1 p	≥2-fold of normal upper limit	1 p
Liver failure (*2)	No	0 p	No	0 p	No	0 p
Liver failure (*2)	Yes	˗3 p	Yes	˗3 p	Yes	˗3 p
DIC diagnosis	≥6 p		≥4 p		≥6 p

p: points
• (*1): For a platelet count of >5 × 10⁴/μL, points will be added if the time-course conditions of decrease are met (no points will be added for a platelet count of ≤5 × 10⁴). The maximum score for the platelet count is 3 points
• For institutions that do not measure FDP (institutions that measure only D-dimer), 1 point will be added if D-dimer increases ≥2-fold the normal upper limit. However, in principle, FDP should also be measured and re-evaluation performed after the results are in hand
• Prothrombin time ratio: If ISI is close to 1.0, INR will also be acceptable (However, there is no evidence supporting recommendation of the use of PT-INR for diagnosis of DIC.)
• Thrombin-antithrombin complex (TAT), soluble fibrin (SF), prothrombin fragment 1+2 (F₁₊₂): For blood sampling in difficult cases and route blood sampling, false-high values may increase. Thus, in comparison with elevation of FDP and/or D-dimer, re-testing should be done if TAT and/or SF is markedly elevated. Confirmation is needed even if the results on the same day are not in time
• Regardless of the presence or absence of DIC immediately after surgery, changes in DIC-like markers such as elevation of TAT, SF, FDP, or D-dimer or a decrease in AT, may be observed, and judgment should be made with care
• (*2) Liver failure: Corresponds to “a prothrombin time activity of ≤40 % or an INR value of ≥1.5 due to severe liver dysfunction seen within eight weeks of onset of initial symptoms following liver impairment that develops in a normal liver or a liver that is thought to exhibit normal liver function” (acute liver failure) or “cirrhosis with a Child-Pugh classification of B or C (≥7 points)” (chronic liver failure) that may be viral or autoimmune in origin, drug-induced, or caused by circulatory failure”
Even when DIC is strongly suspected but these diagnostic criteria are not met, there should be no interference with anti-coagulation therapy based on the physician's judgment, but repeated evaluation is necessary

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