Coagulation monitoring of the bleeding traumatized patient

Death due to trauma is the leading cause of lost life years worldwide, with haemorrhage being responsible for 30-40% of trauma mortality and accounting for almost 50% of the deaths in the initial 24 h. On admission, 25-35% of trauma patients present with coagulopathy, which is associated with a several-fold increase in morbidity and mortality.

Plasma-based routine coagulation tests, like prothrombin time and activated partial thromboplastin time, are inappropriate for monitoring coagulopathy and guide therapy in trauma patients. Instead viscoelastic haemostatic assays (VHAs) such as thrombelastography and rotation thromboelastometry should be used. Clinical studies including about 1500 trauma patients have reported on the benefit of using the VHAs to identify coagulopathy, predict need for massive transfusion and enable goal-directed therapy.

This article reviews the basic principles of VHA, the correlation between the VHA whole blood clot formation in accordance with the cell-based model of haemostasis, the current use of VHA-guided therapy in trauma and limitations of VHA.