Trauma-induced coagulopathy: Mechanisms and clinical management

Introduction: Trauma-induced coagulopathy (TIC) is a form of unique to trauma patients and associated with increased mortality. The complexity incomplete understanding TIC have resulted in controversies regarding optimum management. This review aims summarise the pathophysiology appraise established emerging advances management TIC. Methods: narrative based on literature search (MEDLINE database) completed October 2020. Search terms used were “trauma induced coagulopathy”, “coagulopathy trauma”, pathophysiology”, “massive transfusion “viscoelastic assay “goal directed “fibrinogen coagulopathy’. Results: not uniform phenotype but spectrum ranging from thrombotic bleeding phenotypes. Evidence for tranexamic acid, massive protocols, viscoelastic haemostatic assays (VHAs), coagulation factor fibrinogen concentrates evaluated. Although most centres utilise fixed-ratio “ideal” ratio blood products still debated. While more are using VHAs guide product replacement, there no agreed VHA-based strategy. use VHA quantify functional contributions individual components may permit targeted treatment remains controversial. Conclusion: A greater TIC, point-of-care testing, availability factors allows clinicians employ goal-directed approach. Still, hospitals need tailor their approaches according available resources, provide training establish local guidelines. Keywords: Blood disorders, fibrinolysis, haemorrhage, transfusion,