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Integrated Compensatory Responses in a Human Model of Hemorrhage
Published on: November 20, 2016
Hemostatic Resuscitation in Trauma-Induced Coagulopathy: A Comprehensive Narrative Review
Matteo Matteucci1, Bruno Cirillo2, Francesco Brucchi3
1Department of General Surgery, University of Milan, 20122 Milan, Italy.
Medicina (Kaunas, Lithuania)
|July 28, 2026
Summary
Trauma-induced coagulopathy (TIC) is a major cause of preventable death. Early, balanced resuscitation with fibrinogen and antifibrinolytics improves survival in bleeding trauma patients.
Area of Science:
- Trauma and Emergency Medicine
- Hematology
- Resuscitation Science
Background:
- Traumatic hemorrhage is a leading cause of preventable death, with trauma-induced coagulopathy (TIC) affecting up to one-third of severely injured patients.
- TIC is an endogenous process, not solely due to dilution, hypothermia, or acidosis, necessitating a shift in early resuscitation strategies.
- Understanding TIC's complex pathophysiology is crucial for improving outcomes in major trauma.
Purpose of the Study:
- To review the current literature on the pathophysiology of trauma-induced coagulopathy (TIC).
- To analyze the evolution of hemostatic resuscitation strategies for bleeding trauma patients.
- To evaluate evidence supporting contemporary therapeutic approaches for managing TIC.
Main Methods:
- Narrative review of published literature on TIC pathophysiology and hemostatic resuscitation.
- Analysis of data on balanced transfusion strategies, whole blood, fibrinogen, cryoprecipitate, prothrombin complex concentrates, tranexamic acid, and viscoelastic testing.
- Inclusion of relevant international guidelines for trauma resuscitation.
Main Results:
- Emerging evidence supports early, balanced, and targeted hemostatic resuscitation for improved outcomes in bleeding trauma.
- Balanced transfusion ratios, prompt fibrinogen correction, early antifibrinolytic therapy, and factor concentrates reduce transfusion needs and improve survival.
- Viscoelastic testing offers rapid, individualized coagulation assessment but faces inconsistent implementation.
Conclusions:
- Early recognition and aggressive management of TIC are essential to reduce preventable deaths from traumatic hemorrhage.
- Advances in hemostatic resuscitation have improved outcomes, but standardization and access to diagnostics remain challenging.
- Ongoing research and system optimization are needed to refine and disseminate evidence-based TIC management strategies.
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