title: The pathophysiology, diagnosis and treatment of the acute coagulopathy of trauma and shock: a literature review.
abstract: BACKGROUND
  The acute coagulopathy of trauma and shock is associated with significant mortality and, currently, there are no validated laboratory tests which allow for a rapid recognition and treatment of this condition. Therefore, early detection of any clot abnormality in trauma could improve the diagnosis of trauma-associated coagulopathy and subsequent interventions.
  
  
  METHODS
  Review of the literature.
  
  
  RESULTS
  The standard laboratory tests, including prothrombin time and activated partial thromboplastin time, are unreliable and describe only an isolated fragment of the complex coagulation pathways. Additionally, thromboelastography and thromboelastometry operate in a non-linear regime which implies that clot formation is the product of both the clotting process and the effect of the measurement. The assessment of the clot microstructure using a scanning electron microscope has resulted in a subjective analysis of a clot structure, showing also poor correlation between the coagulation pathways and clot development. The fractal dimension provides information on the structure and quality of the initial clot, which subsequently acts as a template for how the mature clot will behave. However, these data require further verification in an in vivo setting. At present, the treatment of the coagulopathy is delivered by empirically administered massive transfusion protocols, which lack a specific target for replacement therapy.
  
  
  CONCLUSIONS
  There is enough evidence to demonstrate that we urgently need a robust test, which would determine and quantify both the rate and the extent of coagulation abnormalities. This could help to tailor the treatment of coagulopathy according to the patient's needs.
authors.affiliation: General and Vascular Surgery Departments, Regional Trauma Centre, Morriston Hospital, ABM University Health Board, Swansea, SA6 6NL, UK, Jakub.Kaczynski@hotmail.co.uk.
authors.forename: J
authors.initials: J
authors.lastname: Kaczynski
authors.forename: M
authors.initials: M
authors.lastname: Wilczynska
authors.forename: L
authors.initials: L
authors.lastname: Fligelstone
authors.forename: J
authors.initials: J
authors.lastname: Hilton
mesh_terms: D001778:Blood Coagulation Disorders / Q000097:blood / Q000175:diagnosis* / Q000503:physiopathology; D001780:Blood Coagulation Tests / Q000379:methods; D001803:Blood Transfusion / Q000379:methods; D002985:Clinical Protocols; D042241:Early Diagnosis; D005440:Fluid Therapy / Q000379:methods; D006801:Humans; D010314:Partial Thromboplastin Time; D017410:Practice Guidelines as Topic; D011517:Prothrombin Time; D012769:Shock / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D013916:Thrombelastography / Q000379:methods; D014947:Wounds and Injuries / Q000097:blood / Q000150:complications* / Q000503:physiopathology