Time for changing coagulation management in trauma-related massive bleeding.

Area of Science:

• Traumatology
• Hematology
• Critical Care Medicine

Background:

• Trauma-induced coagulopathy (TIC) is a complex condition influenced by blood loss, hypovolemia, and other factors.
• Traditional management of massive blood loss faces challenges due to side effects of intravenous fluids and fresh frozen plasma.
• Advancements in point-of-care diagnostics and understanding of TIC pathophysiology prompt revised management strategies.

Purpose of the Study:

• To review new insights into trauma-induced coagulopathy pathophysiology.
• To explore evolving concepts in managing massive blood loss.
• To highlight the role of point-of-care devices and targeted therapies.

Main Methods:

• Review of current literature on trauma-induced coagulopathy.
• Analysis of the role of viscoelastic devices in diagnosing coagulopathy.
• Evaluation of evidence supporting coagulation factor concentrate therapy.

Main Results:

• TIC results from blood loss, hypovolemia-mediated protein C activation, and fibrinolysis, exacerbated by hemodilution, consumption, hypothermia, acidosis, anemia, and hypocalcemia.
• Viscoelastic devices emphasize fibrinogen's role in clot firmness and bleeding cessation.
• Targeted therapy with coagulation factor concentrates, guided by viscoelastic measurements, shows promise in correcting severe coagulopathy.

Conclusions:

• Viscoelastic measurements should guide aggressive treatment for deficiencies or hyperfibrinolysis during massive blood loss.
• Addressing contributing factors like hypoperfusion is essential.
• Coagulation factor concentrates offer a more effective approach to correcting coagulopathy.