Platelets can undergo at least two distinct types of regulated cell death, apoptosis and mPTP-driven necrosis. Apoptosis is believed to be responsible for platelet clearance, while strong platelet activation by physiological agonists leads to necrosis, producing procoagulant platelet remnants that are essential for blood coagulation during thrombosis and hemostasis. To thoroughly compare morphological and functional features of apoptotic and necrotic-like procoagulant platelets in vitro, their procoagulant activity, ability to bind coagulation proteins, and adhesive protein composition were evaluated. Confocal and electron microscopy were used to analyze morphology. Both apoptotic and necrotic-like procoagulant platelets had balloon-shaped morphology with phosphatidylserine-enriched "caps", as well as similar abilities to bind blood coagulation factors and participate in procoagulant reactions. However, apoptotic platelets did not release their alpha-granules and, consequently, did not have the "coat" of alpha-granular proteins such as P-selectin, fibrin(ogen), and von Willebrand factor on their surface, which was characteristic for the necrotic-like procoagulant ones. They were completely unable to bind external fibrinogen. They were completely unable to bind external fibrinogen. During storage of platelet concentrates, PS-positive platelets of both apoptotic (PS[+]/CD62P[-]) and necrotic-like procoagulant (PS[+]/CD62P[+]) phenotypes were observed to accumulate.

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.