Clinical Management of Severe Bleeding in Trauma Patients

Abstract

Trauma is the leading cause of death between the ages of 1 year and 44 years and uncontrolled bleeding is the primary cause of these deaths. Coagulopathy is a frequent complication of haemorrhage and may occur in up to 25% of patients, even before hospital admission. While traditionally believed to be a result of iatrogenic causes such as dilution, hypothermia and acidosis, Trauma-Induced Coagulopathy (TIC) is now interpreted as amultifactorial global failure of the coagulation system to sustain adequate hemostasis after major trauma. Derangements in coagulation may occur soonafter a severe trauma, thus supporting the hypothesis of an early endogenous process. This acute coagulopathy, which occurs before and independent of iatrogenic reasons, is driven by the combination of tissue trauma and systemic hypoperfusion and characterized by global anticoagulation and hyperfibrinolysis together with a depletion of fibrinogen below levels currently recommended for therapeutic supplementation. In recent years, international guidelines have been developed aimed at preventing and treating trauma-induced coagulopathy.