Revisiting sepsis-induced coagulopathy: limitations of current diagnostic tools and the dawn of targeted therapies

Coagulation disorders constitute a core pathological event in sepsis, and the progression of sepsis-induced coagulopathy (SIC) to disseminated intravascular coagulation (DIC) is a major driver of multi-organ failure and death in septic patients. With deepening understanding of disease pathogenesis, the diagnosis and treatment model of SIC has gradually shifted from controlling bleeding risk-oriented supportive therapy for primary diseases towards a new precision anticoagulation model centering on excessive coagulation activation and emphasizing individualized intervention. Current routine coagulation indicators and scoring systems widely used in clinical practice are mostly static and outdated assessment tools, which fail to reflect the dynamic progression and pathological heterogeneity of the disease. These tools also present prominent limitations such as insufficient early identification and limited accuracy in SIC classification. Novel biomarkers, point-of-care testing for functional coagulation, and artificial intelligence-powered early warning models provide new modalities for early warning, dynamic monitoring and precise classification of SIC. In terms of treatment, the limitations of conventional anticoagulation have become increasingly prominent, and targeted intervention strategies focusing on stratified anticoagulation, endothelial protection and immunothrombosis regulation are progressively emerging as research hotspots, with a variety of novel therapeutic modalities demonstrating potential clinical value. Future efforts should further improve the molecular phenotyping and precise diagnosis and treatment system of SIC. Early identification, dynamic evaluation and individualized intervention are expested to improve the clinical outcomes of SIC patients.