Heatstroke-induced coagulopathy: A scoping review of therapeutic strategies and outcome reporting

Heatstroke-induced coagulopathy (HSIC) is a life-threatening complication of heatstroke that often progresses to disseminated intravascular coagulation. Despite its prognostic significance, standardized treatment strategies have not yet been established. This scoping review aimed to systematically map existing treatment approaches and outcome measures for HSIC in both clinical and experimental research. We conducted a scoping review in accordance with PRISMA-ScR and the Joanna Briggs Institute methodology. Literature searches were conducted in MEDLINE, Web of Science, and Scopus on June 2, 2025. To enhance relevance to contemporary clinical practice, inclusion was limited to studies published from January 2010 onward. Eligible studies included clinical and basic research evaluating treatment interventions for HSIC. A total of 61 studies were included, comprising clinical studies, case reports/series, reviews, editorials, and basic research. Only two clinical studies evaluated treatments using control groups. Anticoagulants such as antithrombin and recombinant thrombomodulin were evaluated, but clinical evidence remained limited. Case reports and case series frequently described transfusion therapies, particularly platelet and fresh frozen plasma administration. However, standardized treatment protocols were lacking, and outcome assessments were mostly descriptive. Basic research explored multiple therapeutic candidates targeting inflammation and coagulation pathways, but clinical application remained limited. These findings suggest that progress in HSIC therapeutics is hampered not only by a lack of controlled trials, but also by the absence of standardized diagnostic criteria, assessment timepoints, and outcome measures across studies. A consensus framework for standardizing diagnostic and outcome reporting in HSIC, alongside multicenter registries and translational research, is an urgent priority for the field.