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Published on: November 8, 2024
From molecular networks to precision therapeutics: the evolving landscape of trauma-induced coagulopathy
Shouyin Jiang1,2,3,4, Lei Wang1,2,3,4, Wenqi Qi1,2,3,4
1Department of Emergency Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China.
Background:
Trauma-induced coagulopathy (TIC) affects approximately one quarter of severely injured patients and is linked to markedly increased mortality. Despite improvements in trauma care, understanding of TIC mechanisms and development of targeted treatment strategies remain limited. This review summarizes recent advances in mechanistic studies and translational research that inform targeted approaches for TIC.
Methods:
A systematic PubMed search identified English-language basic research on TIC published from January 2016 to July 2025. The review focused on studies utilizing established animal models and experimental systems to explore disease mechanisms, intervention strategies, and translational relevance. Included studies were assessed for scientific rigor, clinical significance, and contributions to advancing TIC knowledge.
Results:
Recent research clarifies the contributions of endothelial glycocalyx shedding, platelet dysfunction, and imbalanced coagulation and fibrinolysis to TIC development. Inflammatory processes and immunothrombosis further disrupt hemostasis. Animal studies in a variety of species have improved understanding of the roles of tissue injury, shock, biological sex, comorbidities, and environmental influences. Preclinical progress includes innovations in fluid resuscitation, precise blood component therapy, targeted antifibrinolytics, vasoactive medications, and cellular therapies. Novel diagnostic tools featuring viscoelastic assays and new biomarkers offer promise for earlier detection and better classification of TIC subtypes. However, challenges persist related to species-specific responses, optimal timing of interventions, and individualized treatment.
Conclusion:
Integrating mechanistic and translational research is transforming the concept of TIC into a dynamic, heterogeneous syndrome that requires individualized therapies. Advances in diagnostics and precision interventions will play a critical role in improving global outcomes for trauma patients with TIC.
Insights
Trauma-induced coagulopathy (TIC) is a complex condition impacting severely injured patients. Recent research clarifies its mechanisms and advances precision treatments for better outcomes.
Area of Science:
- Hematology
- Trauma Surgery
- Translational Medicine
Background:
- Trauma-induced coagulopathy (TIC) affects ~25% of severely injured patients, significantly increasing mortality.
- Current understanding of TIC mechanisms and targeted treatments remains limited despite advances in trauma care.
Purpose of the Study:
- To review recent advances in mechanistic studies and translational research for TIC.
- To inform targeted therapeutic approaches for trauma-induced coagulopathy.
Main Methods:
- Systematic PubMed search of English-language basic research on TIC (Jan 2016-July 2025).
- Focused on studies using animal models and experimental systems to explore mechanisms, interventions, and translational relevance.
- Assessed studies for scientific rigor, clinical significance, and contributions to TIC knowledge.
Main Results:
- Clarified roles of endothelial glycocalyx shedding, platelet dysfunction, and coagulation/fibrinolysis imbalance in TIC.
- Highlighted contributions of inflammation, immunothrombosis, tissue injury, shock, sex, comorbidities, and environment.
- Detailed preclinical advances in resuscitation, blood products, antifibrinolytics, vasoactive drugs, and cellular therapies.
- Introduced novel diagnostic tools (viscoelastic assays, biomarkers) for earlier TIC detection and classification.
- Identified challenges in species-specific responses, intervention timing, and individualized treatment.
Conclusions:
- TIC is a dynamic, heterogeneous syndrome requiring individualized therapies, informed by integrated mechanistic and translational research.
- Advances in diagnostics and precision interventions are crucial for improving outcomes in trauma patients with TIC.
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