Coagulopathy: Its pathophysiology and treatment in the injured patient

Brandon H. Tieu, John B. Holcomb, Martin A. Schreiber

    Research output: Contribution to journalReview articlepeer-review

    190 Scopus citations

    Abstract

    Hemorrhage continues to be one of the leading causes of death following trauma. Trauma patients are susceptible to the early development of coagulopathy and the most severely injured patients are coagulopathic on hospital admission. Hypothermia, acidosis, and dilution from standard resuscitation can worsen the presenting coagulopathy and perpetuate bleeding. Early identification of coagulopathy is dependent on clinical awareness and point of care laboratory values. Routinely used laboratory coagulation parameters fail to adequately describe this state. Thrombelastography is a test that can be done at the bedside and uses whole blood to provide a functional evaluation of coagulation. Rapid diagnosis of coagulopathy, followed by prevention or correction of hypothermia and acidosis should be a priority during the initial evaluation and resuscitation. Judicious use of resuscitation fluids and early replacement of coagulation factors will help prevent iatrogenic hemodilution. This review covers the pathophysiology as well as the clinical and laboratory diagnosis of coagulopathy. Prevention and treatment strategies are discussed, including early transfusion of coagulation factors during massive transfusion and the use of recombinant factor VIIa. Damage control resuscitation is briefly discussed, and it involves the combination of hypotensive resuscitation and hemostatic resuscitation. Finally, a description of the use of fresh whole blood in the military setting is included. Its use has been proven to be safe and beneficial in this setting and warrants further investigation as an adjunct to the management of civilian trauma patients.

    Original languageEnglish (US)
    Pages (from-to)1055-1064
    Number of pages10
    JournalWorld journal of surgery
    Volume31
    Issue number5
    DOIs
    StatePublished - May 2007

    ASJC Scopus subject areas

    • Surgery

    Fingerprint

    Dive into the research topics of 'Coagulopathy: Its pathophysiology and treatment in the injured patient'. Together they form a unique fingerprint.

    Cite this