Haemostasis management of massive bleeding.

Area of Science:

• Trauma and Emergency Medicine
• Hematology
• Critical Care Medicine

Background:

• Trauma-induced coagulopathy (TIC) is a common and serious complication in severely injured patients.
• Its complex etiology involves thrombin generation, protein C activation, factor/platelet consumption, hyperfibrinolysis, fluid dilution, hypothermia, and acidosis.
• TIC is an independent predictor of mortality, necessitating prompt and aggressive management.

Purpose of the Study:

• To outline the etiology and contributing factors of trauma-induced coagulopathy.
• To emphasize the importance of early identification of high-risk patients.
• To recommend evidence-based treatment strategies for TIC.

Main Methods:

• Review of current literature on trauma-induced coagulopathy.
• Identification of clinical and diagnostic variables for risk stratification.
• Description of recommended therapeutic interventions.

Main Results:

• Patients with massive blood loss require risk assessment for coagulopathy upon ER admission.
• High-risk patients benefit from tranexamic acid administration.
• Correction of factor and platelet deficiencies with concentrates and balanced transfusion ratios (1:1 plasma to RBCs) is essential.

Conclusions:

• Aggressive treatment of TIC is warranted due to its association with increased mortality.
• Early identification and targeted therapy, including tranexamic acid, factor concentrates, platelets, and balanced plasma transfusion, improve outcomes.
• Recombinant factor VIIa may be considered for persistent bleeding despite optimal management.