title: Potential value of pharmacological protocols in trauma.
abstract: OBJECTIVE
  Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates.
  
  
  RESULTS
  Early and aggressive treatment is mandatory to improve the survival of severely bleeding trauma patients. High ratios of fresh frozen plasma to red blood cells are linked to improved outcome in coagulopathic patients; however, treatment is often delayed because most blood products must first be thawed. Lyophilized plasma potentially overcomes these problems. However, until now only limited data on the use of lyophilized plasma in major trauma are available. VETs provide a rapid and comprehensive overview of the coagulation process. Low maximum clot firmness is associated with increased transfusion requirements, and premature lysis of the clot is indicative of poor outcome. Improvement in clot firmness can be achieved by the administration of fibrinogen concentrate or platelet concentrate, depending on the cause of coagulopathy. Early administration of tranexamic acid improves clot stability and outcome in major trauma. Prothrombin complex concentrate increases thrombin generation, but is potentially associated with increased risk of thromboembolic complications.
  
  
  CONCLUSIONS
  VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates.
authors: Department of Anaesthesiology and Intensive Care, AUVA Trauma Hospital, Salzburg, Austria. herbert.schoechl@auva.at
authors: Herbert
authors: H
authors: Schöchl
authors: Christoph J
authors: CJ
authors: Schlimp
authors: Wolfgang
authors: W
authors: Voelckel
mesh_terms: D001778:Blood Coagulation Disorders / Q000175:diagnosis / Q000188:drug therapy*; D001803:Blood Transfusion; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D005340:Fibrinogen / Q000627:therapeutic use; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D019095:Point-of-Care Systems; D013916:Thrombelastography; D014148:Tranexamic Acid / Q000627:therapeutic use; D014947:Wounds and Injuries / Q000150:complications*
chemical_list: D006490:Hemostatics; D014148:Tranexamic Acid; D005340:Fibrinogen