Clinically relevant concepts of haemostasis and detection of coagulopathy after trauma and surgery.

Major bleeding is associated with a risk of coagulopathy which increases mortality after trauma and surgery. Coagulopathy in these settings is assumed to be caused by a combination of dilution, hypothermia, and acidosis. However, it has recently become clear that coagulopathy is insufficiently explained by this triad since alterations of platelet and endothelial function also are important. In this paper, we would like to contribute to the celebration of the 60th Anniversary of the Revista Española de Anestesiología y Reanimación by describing some new aspects of coagulopathy with particular relevance for medical doctors working within Anesthesiology, Critical Care, and Emergency Medicine. This new appraisal of coagulation underlines the importance of evaluating haemostasis in whole blood. Traditional tests like prothrombin time (PT)/international normalized ratio (INR), and activated partial thromboplastine time (aPTT) assess coagulation only in plasma and does so with an important time delay. Platelet count may be relevant but platelet function must also be considered and that is now possible, also in emergency situations. In the present review,