Trauma-induced coagulopathy: The past, present, and future

Area of Science:

• Traumatology
• Hematology
• Critical Care Medicine

Background:

• Trauma is a leading global cause of death, with uncontrolled hemorrhage a primary driver of preventable mortality.
• Trauma-induced coagulopathy (TIC) is a complex disorder arising from tissue injury and shock, impairing hemostasis.
• TIC is associated with significant morbidity, including organ failure and thromboembolic complications.

Purpose of the Study:

• To review current understanding of the integrated pathways involved in trauma-induced coagulopathy.
• To identify knowledge gaps and future research directions in TIC.
• To inform strategies for reducing trauma-related morbidity and mortality.

Main Methods:

• Literature review of existing research on trauma-induced coagulopathy.
• Analysis of molecular, physiological, and clinical aspects of hemostatic failure in trauma.
• Synthesis of information on distinct but integrated pathways contributing to TIC.

Main Results:

• TIC presents with diverse phenotypes of impaired clot formation and breakdown.
• Endothelial, immune, and inflammatory responses are implicated in TIC pathogenesis.
• Despite advances, mortality from hemorrhage post-injury remains high.

Conclusions:

• A comprehensive understanding of TIC's complex mechanisms is crucial.
• Further research is needed to address knowledge gaps in TIC.
• Improved management strategies targeting TIC pathways are essential for reducing mortality.