title: Coagulation management.
abstract: OBJECTIVE
  Trauma-induced coagulopathy is a frequent complication in severely injured patients. To correct coagulopathy and restore haemostasis, these patients have traditionally been treated with fresh frozen plasma, but in the last decade, there has been a shift from empirical therapy to targeted therapy with coagulation factor concentrates and other haemostatic agents. This review highlights emerging therapeutic options and controversial topics.
  
  
  RESULTS
  Early administration of the antifibrinolytic medication tranexamic acid was shown in the multicentre CRASH-2 trial to be an effective and inexpensive means of decreasing blood loss. Numerous retrospective and experimental studies have shown that the use of coagulation factor concentrates decreases blood loss and may be useful in reducing the need for transfusion of allogeneic blood products. In particular, early use of fibrinogen concentrate and thrombin generators has a positive impact on haemostasis. However, the use of prothrombin complex concentrate to correct trauma-induced coagulopathy has also been associated with a potential risk of serious adverse events.
  
  
  CONCLUSIONS
  Current evidence in trauma resuscitation indicates a potential role for coagulation factor concentrates and other haemostatic agents in correcting trauma-induced coagulopathy. Despite a shift towards such transfusion strategy, there remains a shortage of data to support this approach.
authors.affiliation: Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, North Rhine-Westphalia, Germany. ogrottke@ukaachen.de
authors.forename: Oliver
authors.initials: O
authors.lastname: Grottke
mesh_terms: D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D001779:Blood Coagulation Factors / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D006801:Humans; D014148:Tranexamic Acid / Q000627:therapeutic use; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D000933:Antifibrinolytic Agents; D001779:Blood Coagulation Factors; D014148:Tranexamic Acid