Natural products in treatment and management of sepsis-induced coagulopathy: Pharmacological basis and mechanisms.

Abstract

<h4>Background</h4>Sepsis-induced coagulopathy (SIC) is a life-threatening complication driven by a dysregulated thromboinflammatory response, closely linked to multiple organ dysfunction and high mortality. However, current therapeutic strategies, including anticoagulants or endogenous anticoagulant replacement, are controversial due to limited efficacy and substantial bleeding risks, creating an urgent need for novel interventions.<h4>Purpose</h4>This review aims to provide a comprehensive overview of SIC pathophysiology and to systematically summarize the pharmacological basis and mechanisms of natural products, highlighting their potential as multi-target agents to restore coagulopathy-hemostatic balance in SIC.<h4>Study design</h4>A systematic literature review was conducted to identify and analyze relevant preclinical and clinical studies.<h4>Materials and methods</h4>Systematic literature searches were conducted in PubMed, Web of Science, and CNKI databases covering studies published up to the present. Medical Subject Headings (MeSH) and keywords related to "sepsis-induced coagulopathy," "sepsis," "natural products," and "coagulopathy" were utilized. Studies reporting the pharmacological effects of natural products on SIC models (in vivo/in vitro) or clinical trials were included.<h4>Results</h4>The search yielded 1623 records, of which 77 studies met the inclusion criteria. The review identified a diverse array of natural products, including isolated compounds (e.g., emodin, ginsenoside) and traditional herbal formulas (e.g., Xuebijing), that exert pleiotropic effects. Mechanistic analysis revealed that natural products exert multi-target effects on the key pathophysiological processes of SIC, including targeting coagulation activation, inhibiting platelet-mediated thrombosis, preserving endothelial function, restoring natural anticoagulant mechanisms, and modulating fibrinolysis-effects that enable them to rebalance the dysregulated thromboinflammation underlying SIC.<h4>Conclusion</h4>Natural products offer a distinct multi-target therapeutic advantage over conventional single-target anticoagulants, effectively rebalancing the dysregulated thromboinflammatory network. Translating this potential into clinical practice requires strict adherence to the proposed roadmap: ensuring standardized preparation, defining precise therapeutic windows, and validating efficacy through rigorous, large-scale RCTs.