Trauma Induced Coagulopathy: Prevention and Intervention

Trauma is associated with 1 in 10 deaths, with approximately 5.8 million mortalities annually worldwide [1]. Significant traumatic bleeding is associated with a poor outcome, with a total mortality of 30%, and is the leading cause of preventable death. Trauma and massive transfusion are associated with trauma induced coagulopathy (TIC), which triggers secondary hypoperfusion, dilutional coagulopathy and dilutional thrombocytopenia, and consumptive coagulopathy of clotting factors and metabolic acidosis, as well as hypothermia, which further enhances this vicious cascade leading to further blood loss. The concept of damage control resuscitation has evolved, which emphasizes early control of bleeding with damage control surgical techniques, early use of blood products with limited crystalloid for resuscitation, and permissive hypotension before hemostasis [2]. While control of the hemorrhage for a bleeding patient must always be the utmost priority, understanding the pathophysiology of TIC, and potential for intervention fosters a more comprehensive approach to this complex phenomenon. Recently, viscoelastic whole blood assay with Thromboelastography (TEG) has been applied to the trauma patient for evaluation in real time of clot strength that can target specific therapies to facilitate hemostatic control.