Opening the Door for the New Era of Managing Sepsis-induced Coagulopathy
Abstract
Sepsis-associated disseminated intravascular coagulation (DIC) is a dynamic thromboinflammatory syndrome characterized by dysregulated coagulation, impaired fibrinolysis, platelet and leukocyte activation, endothelial injury, and microvascular thrombosis, ultimately leading to organ dysfunction and increased mortality. Recent advances in the understanding of its pathophysiology have shifted the concept of DIC from an irreversible end-stage complication to a potentially reversible condition when recognized and treated early. The updated 2025 International Society on Thrombosis and Haemostasis (ISTH) definition emphasizes disease progression from an early, often asymptomatic phase to overt DIC, supporting stage-specific diagnosis and intervention. In particular, recognition of sepsis-induced coagulopathy (SIC) as a precursor to overt DIC provides a valuable therapeutic window before irreversible organ damage develops. Current therapeutic strategies include heparins, physiological anticoagulants, and recombinant thrombomodulin, although their clinical benefits remain inconsistent because of patient heterogeneity and bleeding complications. Emerging approaches, including factor XI inhibitors, neutrophil elastase inhibitors, targeted fibrinolytic therapies, and nanotechnology-based drug delivery systems, aim to preserve antithrombotic efficacy while minimizing bleeding risk. Future management of sepsis-associated DIC will depend on earlier diagnosis, accurate disease staging, risk stratification, and personalized therapeutic strategies tailored to distinct coagulation phenotypes, thereby opening a new era in improving outcomes for patients with septic coagulopathy.
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BibTeX
@article{kondo2026opening,
title = {{Opening the Door for the New Era of Managing Sepsis-induced Coagulopathy}},
author = {KENTA KONDO and MAKOTO HIKI and TOSHIAKI IBA and YUTAKA KONDO},
journal = {Juntendo Medical Journal},
year = {2026},
month = sep,
url = {https://europepmc.org/article/MED/42973830},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Opening the Door for the New Era of Managing Sepsis-induced Coagulopathy
AU - KENTA KONDO
AU - MAKOTO HIKI
AU - TOSHIAKI IBA
AU - YUTAKA KONDO
PY - 2026
DA - 2026/09/07
JO - Juntendo Medical Journal
UR - https://europepmc.org/article/MED/42973830
AB - Sepsis-associated disseminated intravascular coagulation (DIC) is a dynamic thromboinflammatory syndrome characterized by dysregulated coagulation, impaired fibrinolysis, platelet and leukocyte activation, endothelial injury, and microvascular thrombosis, ultimately leading to organ dysfunction and increased mortality. Recent advances in the understanding of its pathophysiology have shifted the concept of DIC from an irreversible end-stage complication to a potentially reversible condition when recognized and treated early. The updated 2025 International Society on Thrombosis and Haemostasis (ISTH) definition emphasizes disease progression from an early, often asymptomatic phase to overt DIC, supporting stage-specific diagnosis and intervention. In particular, recognition of sepsis-induced coagulopathy (SIC) as a precursor to overt DIC provides a valuable therapeutic window before irreversible organ damage develops. Current therapeutic strategies include heparins, physiological anticoagulants, and recombinant thrombomodulin, although their clinical benefits remain inconsistent because of patient heterogeneity and bleeding complications. Emerging approaches, including factor XI inhibitors, neutrophil elastase inhibitors, targeted fibrinolytic therapies, and nanotechnology-based drug delivery systems, aim to preserve antithrombotic efficacy while minimizing bleeding risk. Future management of sepsis-associated DIC will depend on earlier diagnosis, accurate disease staging, risk stratification, and personalized therapeutic strategies tailored to distinct coagulation phenotypes, thereby opening a new era in improving outcomes for patients with septic coagulopathy.
SN - 2759-7504
ER -