Fibrinolysis in trauma: a review.

Area of Science:

• Coagulation and Hemostasis
• Trauma Pathophysiology
• Fibrinolysis

Background:

• Fibrinolytic dysregulation is a key factor in traumatic coagulopathy, with implications for patient outcomes.
• This dysregulation encompasses both excessive breakdown (hyperfibrinolysis) and impaired fibrinolysis (shutdown).
• Both extremes are linked to increased mortality and organ failure post-trauma.

Purpose of the Study:

• To review the current evidence on the pathophysiology of fibrinolytic dysregulation in trauma.
• To discuss the diagnostic challenges and potential of viscoelastic studies.
• To examine the multimodal management strategies and controversies in antifibrinolytic therapy.

Main Methods:

• Literature review of current evidence.
• Analysis of pathophysiology, diagnostic modalities, and treatment strategies.
• Focus on fibrinolytic dysregulation in the context of traumatic coagulopathy.

Main Results:

• Fibrinolytic dysregulation is multifactorial, involving endothelial injury and hypoperfusion.
• Viscoelastic studies show promise for rapid identification of fibrinolytic abnormalities.
• Treatment is complex, with ongoing debate regarding antifibrinolytic agents.

Conclusions:

• Fibrinolytic dysregulation significantly impacts trauma outcomes.
• Timely diagnosis via viscoelastic studies is crucial.
• Management requires a multimodal approach, with careful consideration of antifibrinolytic therapy.