Acute traumatic coagulopathy and trauma-induced coagulopathy: an overview

Shigeki Kushimoto,Yu Kawazoe,Daisuke Kudo

doi:10.1186/s40560-016-0196-6

Shigeki Kushimoto, Yu Kawazoe + Show 1 more

Open Access

https://doi.org/10.1186/s40560-016-0196-6

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Abstract

Hemorrhage is the most important contributing factor of acute-phase mortality in trauma patients. Previously, traumatologists and investigators identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, including hypothermia, metabolic acidosis, and dilutional coagulopathy that were recognized as primary drivers of bleeding after trauma. However, the last 10 years has seen a widespread paradigm shift in the resuscitation of critically injured patients, and there has been a dramatic evolution in our understanding of trauma-induced coagulopathy. Although there is no consensus regarding a definition or an approach to the classification and naming of trauma-associated coagulation impairment, trauma itself and/or traumatic shock-induced endogenous coagulopathy are both referred to as acute traumatic coagulopathy (ATC), and multifactorial trauma-associated coagulation impairment, including ATC and resuscitation-associated coagulopathy is recognized as trauma-induced coagulopathy. Understanding the pathophysiology of trauma-induced coagulopathy is vitally important, especially with respect to the critical issue of establishing therapeutic strategies for the management of patients with severe trauma.

Highlights

Trauma remains a leading cause of death and permanent disability in adults despite advances in systematic approaches including prevention, resuscitation, surgical management, and critical care [1]
The mortality of trauma patients requiring massive transfusion exceeds 50% [3], at least 10% of deaths after traumatic injury are potentially preventable, and 15% of those are due to hemorrhage; many of these deaths occur within the first few hours of definitive care, with coagulopathy playing a crucial role [4,5,6]
Previous landmark studies identified iatrogenic and resuscitation-associated causes of coagulopathic bleeding after traumatic injury, of which hypothermia, metabolic acidosis, and dilutional coagulopathy were recognized as primary drivers of bleeding after trauma [9,10,11]

Summary

Introduction

Trauma remains a leading cause of death and permanent disability in adults despite advances in systematic approaches including prevention, resuscitation, surgical management, and critical care [1]. Coagulopathy in the acute phase of trauma patients consists of two core components: (1) trauma itself and/ or traumatic shock-induced endogenous ATC and (2) resuscitation-associated coagulopathy [20] (Fig. 1). The clinical features and pathophysiology of trauma-induced coagulopathy have been recognized as the comprehensive condition of ATC involving resuscitationassociated coagulopathy, a systemic inflammatory response to tissue injury, and predisposing factors [23].

Results

Conclusion