Trauma-induced coagulopathy

Abstract

Massive bleeding is the most common cause of death in trauma. The famous concept of the “Lethal triad” explains how bleeding causes a fatality. Meanwhile, “Trauma-induced coagulopathy; TIC” explains what is going on after massive hemorrhages. TIC is the summation of impaired clot formation, dysregulation of fibrinolysis, and platelets dysfunction. These factors induce worsening bleeding, leading to shock and death subsequently. Conventional coagulation tests may not be suitable to diagnose TIC in the trauma bay. The viscoelastic hemostatic assay utilizes to analyze and guide proper TIC treatment currently. Treating TIC aims to control bleeding and give adequate end-organ perfusion, including massive transfusion (MT) and damage control resuscitation (DCR). The principles of DCR consist of damage control surgery, rapid rewarming, permissive hypotension, limited crystalloid transfusion, ratio-based blood component therapy, and correction of hyperfibrinolysis.  

Keyword: Trauma-induced coagulopathy, Massive bleeding, Viscoelastic hemostatic assay, Massive transfusion, Damage control resuscitation, Trauma