Trauma-Induced Coagulopathy: Diagnosis and Management in 2020

AbstractPurpose of ReviewThis review describes the mechanisms underlying trauma-induced coagulopathy (TIC) and the current strategies to measure and mitigate the negative effects of TIC during the initial stages of trauma resuscitation and care.Recent FindingsTrauma patients can manifest both early hypocoagulable and later hypercoagulable phenotypes. These are not fixed states and patient transition between states postinjury. Recent trends in resuscitation, driven by the military experience, have promoted the return to whole blood as the initial resuscitative fluid in the severely injured patient, but goal-directed blood product administration remains critically important to restore coagulation homeostasis and avoid microvascular thrombotic events.SummaryAs our understanding of TIC improves, we anticipate that whole blood resuscitation will replace empiric ratios for the severely injured patient with uncontrolled cavitary bleeding with a transition to goal-directed resuscitation and de-escalation of blood product administration once mechanical hemostasis is achieved.
Source: Current Anesthesiology Reports - Category: Anesthesiology Source Type: research