Acute traumatic coagulopathy in severe injury: incidence, risk stratification, and treatment options

Clinical observation and research findings show that acute traumatic coagulopathy (ATC) is a major factor that must be addressed in the care of severely injured patients. In this review article, we discuss the incidence and causes of ATC, the potential means of early risk stratification for it, and recommendations for its treatment.

We selectively reviewed the pertinent literature and retrospectively analyzed data from the Trauma Registry of the German Trauma Society (Traumaregister der Deutschen Gesellschaft für Unfallchirurgie, TR-DGU) relating to the incidence, causes, and outcome of ATC. We provide an overview of current treatment recommendations, supplemented by our own findings regarding the ratio of packed red blood cell concentrate (pRBC) to fresh-frozen plasma (FFP) transfusion and regarding coagulation-factor-based treatments for coagulopathy in the acute phase after trauma.

ATC, a condition associated with increased morbidity and mortality, is seen on admission in one out of four patients with major trauma. The main causes of ATC are tissue damage, hypoperfusion, hemodilution, hypothermia, acidosis, and inflammation. It may be possible to identify patients at risk for ATC early on through the use of rapidly calculable, predictive numerical scales (McLaughlinScore, TASH, and ABC), laboratory tests, and imaging studies (FAST and CT). Acute treatment is focused on the control of bleeding and support of the coagulation system according to the current guidelines. Patients at high risk may benefit from a balanced transfusion strategy. Innovative strategies currently under study include point-of-care-guided treatment and coagulation-factor-concentrate-based treatment.