Point of Care: Assessment of Coagulopathy in Hemorrhagic Shock

Abstract

Correspondence to: Jung-Min Bae, M.D. Department of Surgery, Yeungnam University College of Medicine, 170 Hyeonchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3580 Fax: +82-53-624-1213 E-mail: netetern@naver.com Traumatic bleeding is a prime cause of mortality after trauma, responsible for 40% of traumarelated early death. Traumatic bleeding often occurs as direct bleeding from injured site and is frequently complicated by trauma-induced coagulopathy (TIC). Traditionally, TIC was related to hemodilution, coagulation factor consumption, acidosis and hypothermia. However, TIC is now considered shock-associated hypoperfusion, a combination that activates the protein C pathway. While this adds to the understanding of this condition, the pathophysiology of TIC is not fully understood. Because TIC is composed of multiple factors, point-of-care testing (POCT) of coagulopathy that can rapidly provide information on an individual patient’s coagulation status is important. Among POCT tests are viscoelastic tests (VET), of which the most commonly used are thromboelastography and thromboelastometry. These provide rapid and dynamic bedside assessment of TIC. Treatment algorithms using VET results reduce mortality, morbidity and amount of transfusion. Although VET offers several advantages, there are limitations. VET cannot reduce mortality and morbidity, cannot fully assess the entire coagulation process, need ongoing quality control protocols, and require trained personnel. In conclusion, despite its limitations, VET has many advantages in assessment of TIC, POCT and treatment of TIC. Efforts to overcome the limitations are needed. (J Acute Care Surg 2015;5:42-46)