Management of Postinjury Coagulopathy

Abstract

SUMMARYCoagulopathy is commonly seen in seriously injured patients and can make control of hemorrhage more difficult. An observed defect in blood clotting may be preexisting, due to severe injury, a result of delayed treatment, or exacerbated by resuscitation efforts. Factors that promote coagulopathy include hypothermia, acidosis, intravascular consumption and extravascular loss of coagulation factors and platelets, reduced platelet effectiveness secondary to low hematocrit, interactions of coagulation proteins and platelets with volume expanders, and the hemodilution associated with massive transfusion. Management of the hemorrhagic diathesis involves treatment of hypothermia, avoidance of excessive colloid and crystalloid volume in the resuscitation effort, damage‐control surgery, appropriate use of blood products and, in selected cases, the use of tissue sealants and recombinant factor VIIa.