Coagulopathy in trauma patients: what are the main influence factors?
OBJECTIVE
Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue. Uncompensated hemorrhage often culminates in death, highlighting the significance of recognizing the main influences in coagulopathy of trauma.


RESULTS
With recent improvements in prehospital care, trauma specialists face more challenging cases than ever before. Hemostatic transfusion strategies, with early and more aggressive use of plasma, platelets, cryoprecipitate and coagulation factor isolates, decrease blood loss in trauma patients. Combined with point-of-care testing for thromboelastography, coagulation panels, lactate and local pO2, there is an opportunity for frontline trauma clinicians to directly improve patient outcomes.


CONCLUSIONS
Although mortality previously was thought to be summarily independent of medical interventions and resuscitations, we now know the opposite to be true; it is our expectation and indeed our obligation to recognize and manage the coagulopathy of trauma better than in past years. In as much as we continue to prevent acidosis, hypothermia and the progressive coagulopathy following injury, trauma victims the world over are benefiting and surviving longer, living proof that demonstrates the utility of managing the coagulopathy of trauma.
Maani
Christopher V
CV
Department of Anesthesiology, USA Institute of Surgical Research and Army Burn Center, Brooke Army Medical Center, Fort Sam Houston 78234, USA. Christopher.Maani@us.army.mil
DeSocio
Peter A
PA
Holcomb
John B
JB
D000138:Acidosis / Q000150:complications*; D001778:Blood Coagulation Disorders / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D001780:Blood Coagulation Tests; D006438:Hemodilution / Q000009:adverse effects; D006470:Hemorrhage / Q000209:etiology / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D007035:Hypothermia / Q000150:complications*; D065227:Transfusion Reaction; D014947:Wounds and Injuries / Q000150:complications / Q000503:physiopathology* / Q000628:therapy