Recognizing Coagulation Disorders in Sepsis in the Emergency Room: A Narrative Review.

Area of Science:

• Critical Care Medicine
• Hematology
• Emergency Medicine

Background:

• Sepsis is a major cause of death globally, with early emergency department (ED) management critical for outcomes.
• Coagulation abnormalities are early signs of sepsis, reflecting dysregulated host response, endothelial injury, and microvascular thrombosis.
• Sepsis-induced coagulopathy (SIC) and disseminated intravascular coagulation (DIC) are often underrecognized in the ED, viewed primarily as bleeding risks rather than thromboinflammatory markers.

Purpose of the Study:

• To review the mechanisms linking sepsis, endothelial dysfunction, and coagulation abnormalities.
• To clarify the distinction between SIC and overt DIC.
• To emphasize the importance of early coagulopathy detection in the ED for improved sepsis management.

Main Methods:

• Narrative review synthesizing current understanding of sepsis and coagulation.
• Discussion of practical bedside approaches, including laboratory testing and validated scoring systems (SIC, ISTH DIC criteria).
• Exploration of system-level strategies for early detection, such as sepsis bundles and improved ED-ICU communication.

Main Results:

• Coagulation abnormalities are fundamental to sepsis pathophysiology, not just lab disturbances.
• Early identification of SIC/DIC in the ED can refine risk stratification and guide triage.
• Recognizing coagulopathy reframes sepsis as a thromboinflammatory syndrome, potentially benefiting from targeted anticoagulation.

Conclusions:

• Early recognition and management of SIC/DIC in the ED are essential for improving sepsis outcomes.
• Coagulation testing in sepsis should be viewed as a marker of systemic thromboinflammation.
• Integrating coagulation assessment into sepsis care pathways can enhance patient management and outcomes.