Acute Coagulopathy of Trauma

OVERVIEW

  • new terms that are in vogue are trauma-induced coagulopathy (TIC) and acute traumatic coagulopathy (ATC)
  • not simply a ‘dilutional coagulopathy’ or ‘consumptive coagulopathy’!

PATHOPHYSIOLOGY

  • TIC was conventionally construed simply as depletion, dysfunction or dilution of procoagulant factors
  • actually an imbalance of the dynamic equilibrium between procoagulant factors, anticoagulant factors, platelets, endothelium and fibrinolysis
  • characterized by isolated factor V inhibition, dysfibrinogenemia, systemic anticoagulation, impaired platelet function and hyperfibrinolysis
  • exacerbated by hypothermia, acidosis (together with coagulopathy they form ‘the lethal triad’) and resuscitation with hypocoagulable fluids

MANAGEMENT

  • early detection (ROTEM /TEG holds promise for this)
  • early activation of massive transfusion protocols
  • aggressive proactive blood product administration (PRBCs, FFP, platelets, cryoprecipitate)
  • prevent and treat hypothermia and acidosis
  • early use of tranexamic acid
  • give calcium if hypocalcaemic
  • consider Factor VII if non-surgical bleeding and all the other parameters have been corrected

References and Links

  • Frith D, Brohi K. The pathophysiology of trauma-induced coagulopathy. Curr Opin Crit Care. 2012 Dec;18(6):631-6. PMID: 23010636.
  • Frith D, Davenport R, Brohi K. Acute traumatic coagulopathy. Curr Opin Anaesthesiol. 2012 Apr;25(2):229-34. PMID: 22270921.

CCC 700 6

Critical Care

Compendium

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