TOPLINE:

Among patients with sepsis and coagulopathy who underwent abdominal radiologic intervention in the emergency department (ED), correction of coagulopathy was associated with delayed source control and nearly a twofold increase in 28-day mortality, without a reduction in the incidence of major bleeding complications.

METHODOLOGY:

• Researchers performed a retrospective cohort study of 597 adult patients (median age, 74 years; 46.6% women) diagnosed with sepsis or septic shock who underwent abdominal radiologic intervention for the control of infection source at the ED of a tertiary hospital from 2011 to 2020.
• Based on initial ED blood tests, patients were categorized as those with coagulopathy and those without. Within the coagulopathy group (n = 161), outcomes were compared between patients who received correction — transfusion of platelets, fresh frozen plasma, or cryoprecipitate or administration of vitamin K — before the intervention (n = 55) and those who did not (n = 106).
• The primary outcome was 28-day mortality, and the secondary outcome was the incidence of major bleeding complications; additionally, the effects of coagulopathy correction on time to intervention were examined.

TAKEAWAY:

• Patients who underwent coagulopathy correction had a higher 28-day mortality rate than those who did not undergo correction (41.8% vs 22.6%; P = .02). A strong association was confirmed between coagulopathy correction and a higher 28-day mortality rate (odds ratio [OR], 2.52; P = .03).
• No significant difference between the two groups was observed in the prevalence of major bleeding complications (OR, 1.80; P = .13).
• Patients who underwent coagulopathy correction had a significantly longer time to intervention than those who did not undergo correction (15.3 h vs 6.0 h; P < .001).

IN PRACTICE:

"Our findings indicate that delays associated with coagulopathy correction may paradoxically worsen outcomes, suggesting that timely intervention for infection source control may be a more critical outcome determinant than prophylaxis against bleeding complications. In patients with sepsis, coagulopathy should not be viewed merely as a laboratory abnormality to be corrected but rather as a marker of disease severity," the authors wrote.

SOURCE:

The study was led by Yeonjin Jo, MD, and Seung Hyun Kang, MD, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea. It was published online on July 24, 2025, in the American Journal of Emergency Medicine.

LIMITATIONS:

The study's single-center retrospective design may have limited its generalizability and introduced selection bias. The absence of a standardized protocol for coagulopathy correction may have influenced the observed association with higher mortality. The relatively small number of patients with coagulopathy undergoing abdominal radiologic intervention may have reduced the study's statistical power, potentially underestimating associations, particularly for bleeding outcomes.

DISCLOSURES:

The study did not receive any specific funding, and the authors reported having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.