For the urgent need to develop a point-of-care test (POCT) method for coagulation detection that is rapid, sensitive, accurate, real-time, and environment-independent, the sensing principles and models of acoustic sensors used in coagulation detection were analyzed and summarized following the introduction of the main physical and chemical changes and corresponding parameters in the process of coagulation. The coagulation process consists of a series of enzyme-linked reactions promoted by coagulation factors triggered by endogenous or exogenous activators and the physical parameters such as blood viscosity, shear resistance, and density change accordingly. Acoustic sensors were adopted to detect the physical parameters in the coagulation process. The relationship between the samples and the coagulation time, thrombus dynamics, protein content, and so on was elaborated and provided information for the patient’s clotting state. In this paper, the sensing principle and mathematical model of quartz crystal microbalance (QCM), surface acoustic wave (SAW) sensor, thin-film bulk acoustic resonator (FBAR), and Lamb wave sensor were introduced. The design idea and hot points of the acoustic sensors were discussed in terms of structure, piezoelectric material, sensitive film, and processing technology. Combined with the characteristics of blood samples, the relationship between acoustic signals and the coagulation process was analyzed, and the application of acoustic sensors in coagulation detection was summarized and prospected. In addition, the application and research hotspots of microfluidic chips integrated with acoustic sensors for coagulation detection have been included, because the integration of the acoustic sensors into the microfluidic chip can help to control the environment and operation conditions for coagulation testing, which can better meet the needs of POC coagulation testing. Finally, the challenges and future development for coagulation detection of acoustic sensors were discussed and prospected.